MolDX: Biomarkers in Cardiovascular Risk Assessment

Medicare Part B covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C) as a preventive screening test every 5 years and covers diagnostic/monitoring lipid panel testing for symptomatic patients under NCD 190.23. Coverage for biomarkers beyond the basic lipid panel is restricted: individual lipid biomarkers may be covered if specifically ordered with a documented clinical reason to characterize lipid abnormalities or guide therapy, but multianalyte CV risk panels and all non-lipid biomarkers for CV risk assessment are not covered. Hs-CRP has narrowly defined conditional use (contractor-expectation criteria for intermediate-risk patients) but is not covered for treatment monitoring or to motivate lifestyle changes, and there is no coverage for screening asymptomatic individuals.

"Medicare Part B covers the basic lipid panel (total cholesterol, HDL-C, triglycerides, and LDL-C) as a preventive CV disease screening test when ordered by a physician, with screening allowed every..."