MolDX: Biomarkers in Cardiovascular Risk Assessment
L36139
Medicare Part B covers the basic lipid panel for preventive cardiovascular screening every 5 years and covers lipid panel testing for symptomatic patients to evaluate or monitor atherosclerotic cardiovascular disease per NCD 190.23. Coverage for multi-analyte cardiovascular risk panels is denied, and non-lipid biomarkers (e.g., BNP, Lp-PLA2, cystatin C, inflammatory markers, genomic profiles, homocysteine/MTHFR, etc.) are not covered for CV risk assessment; individual lipid biomarkers may be covered only when specifically ordered with the clinical reason documented. hs-CRP may be considered in narrowly defined intermediate-risk scenarios (10-year Framingham risk 10–20%, LDL-C 100–130 mg/dL, and ≥2 CHD risk factors) with appropriate documentation, but is not covered for routine screening, therapeutic monitoring, or to motivate lifestyle changes.
"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."