MolDX: Biomarkers in Cardiovascular Risk Assessment

Medicare covers the basic lipid panel as a preventive service every 5 years and covers lipid panels for symptomatic patients under NCD 190.23 to evaluate or monitor atherosclerotic cardiovascular disease. Multi-biomarker cardiovascular risk panels and non-lipid biomarkers are denied for CV risk assessment, while certain individual lipid-related tests (e.g., LDL particle number/ApoB, and hs-CRP) may be considered in specified clinical scenarios when specifically ordered and justified in the medical record. Screening asymptomatic patients for CV risk is statutorily excluded from Medicare coverage.

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

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