86141
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Claims should be supported with documentation consistent with LCD L36129; this article provides billing and coding guidelines that complement that LCD and should be used alongside the LCD when submitting claims.
- Billing, coding, and guideline information herein complement and must be used in conjunction with the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (LCD L36358); follow LCD L36358 for clinical criteria and claim adjudication.
- Required documentation and claim substantiation should follow the documentation requirements and MolDX program instructions in LCD L36362; no additional specific forms or certifications are specified in this article.
- Article provides billing, coding, and guideline information that complements LCD L36139; claims must follow the LCD and MolDX program requirements (including appropriate CPT/HCPCS and ICD-10 coding and any LCD-required documentation or prior authorization).
Key Coverage Criteria
- No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
- This article contains billing and coding guidance only and does not itself define clinical indications; refer to MolDX: Biomarkers in Cardiovascular Risk Assessment LCD L36139 for covered clinical indications.
- Basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) is covered as a Medicare Part B preventive service when ordered by a physician (coverage noted every 5 years).
- Lipid panel testing is covered for symptomatic patients to evaluate atherosclerotic cardiovascular disease and to monitor progress on anti-lipid dietary management or pharmacologic therapy (per NCD 190.23).
- Individual lipid biomarkers (ordered singly, not as part of a CV risk assessment panel) may be covered when specifically ordered to characterize a lipid abnormality, determine a treatment plan, or assist with therapy intensification, provided the medical reason is documented in the medical record.
- Medicare Part B covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) for cardiovascular disease screening every 5 years when ordered by a physician.
14 Active Policies
A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment
J05
A57055 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
A57386 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment
L36129 — MolDX: Biomarkers in Cardiovascular Risk Assessment
Related Codes
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