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Billing Medicare for Cardiovascular Screening Tests

Effective with services performed on or after January 1, 2005, Medicare provides coverage of cardiovascular screening blood tests for the early detection of cardiovascular disease or abnormalities associated with an elevated risk of heart disease and stroke.

The covered screening tests are:

1. Total Cholesterol Test
2. Cholesterol Test for High-Density Lipoproteins
3. Triglycerides Test

Please note: The beneficiary must fast for 12 hours prior to a test.

Medicare provides coverage of cardiovascular screening blood tests for all asymptomatic beneficiaires every 5 years (i.e., at least 59 months after the last covered screening tests).

Medicare Part B covers cardiovascular screening blood tests when ordered by a physician or qualified non-physician practitioner who is treating a beneficiary without apparent signs or symptoms for the purpose of early detection of cardiovascular disease.

The following CPT codes are used to bill for Medicare-covered Cardiovascular screening tests:

CPT 80061 - Lipid panel (includes CPT codes 82465, 83718, and 84478)
CPT 82465 - Total cholesterol, serum or whole blood
CPT 83718 - HDL cholesterol
CPT 84478 - Triglycerides

When all 3 tests are ordered together, they should be reported using code 80061. However, when individual tests are ordered, the following
ICD-9 diagnostic codes must be used:

ICD V81.0: special screening for cardiovascular disease, ischemic heart disease;

ICD V81.1: special screening for cardiovascular disease, hypertension;

ICD V81.2: special screening for cardiovascular disease; other and unspecified cardiovascular conditions.

All of the above test codes are included in the Medicare Laboratory Fee Schedule. No patient co-payment applies to tests on the Medicare Laboratory Fee Schedule. The patient pays nothing, and the entire scheduled fee amount is paid to the provider.

You could review the 2010 Medicare Laboratory Fee Schedules for all the states @

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