MolDX: Biomarkers in Cardiovascular Risk Assessment

Medicare covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) as indicated (preventive Part B benefit noted every 5 years and for symptomatic patients per NCD 190.23) and permits individual lipid biomarkers only when ordered singly with the clinical reason documented. Medicare denies coverage for multi-analyte cardiovascular risk assessment panels and for all non-lipid biomarkers listed (e.g., Lp-PLA2, BNP, cystatin C, inflammatory and genomic markers) and excludes screening testing in asymptomatic individuals; hs-CRP monitoring for treatment response or to motivate behavior change is not covered. Specific documentation (individual order and clinical justification; Framingham 10-year risk and risk-factor documentation when used for hs-CRP) is required and acute-use BNP follows separate LCD coverage rules.

"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)."