Screening for Lipid Disorders

Aetna covers serum triglycerides, total cholesterol and HDL-C screening and will cover direct LDL-C measurement only when selection criteria are met—specifically for patients with triglycerides >250 mg/dL and for persons with type 2 diabetes—and considers direct VLDL measurement, breath isoprene, cholesterol skin testing, and direct LDL-C in persons without diabetes or hypertriglyceridemia experimental/investigational and not covered (CPT 83719 not covered). Cholesterol screening of asymptomatic members is not covered if the member’s plan excludes preventive services, diagnostic testing is covered when medically necessary, and per NCEP guidance direct LDL measurement is recommended when triglycerides >400 mg/dL (250–400 mg/dL reduces accuracy of calculated LDL).

"Cholesterol screening of asymptomatic persons is not covered for members whose plans do not provide coverage for preventive services. Diagnostic cholesterol testing is covered when medically necess..."