MolDX: Biomarkers in Cardiovascular Risk Assessment

Medicare covers the basic lipid panel as a preventive service every five years and covers lipid panel testing for symptomatic patients under NCD 190.23. Specialized lipid tests (eg, LDL‑P, ApoB) may be covered in specific clinical situations to assess residual risk or guide therapy when individually ordered and documented, whereas multi‑analyte cardiovascular risk panels and non‑lipid biomarkers (eg, BNP, cystatin C, inflammatory markers, genomic profiles) used for CV risk assessment are not covered. hs-CRP may be considered for limited risk stratification when documented criteria are met (intermediate Framingham risk, LDL-C 100–130 mg/dL, ≥2 major risk factors) and must be documented with two measurements ~2 weeks apart; hs-CRP is not covered for treatment monitoring or for screening asymptomatic patients.

"Medicare Part B covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) as a preventive service when ordered by a physician, with coverage every 5 years."