CPT code 80061

(2022) CPT Code 80061 – Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 80061 is used to bill a Lipid Panel test. This panel test is performed to screen lipid-protein in the bloodstream of the patient’s body.

The test samples are retrieved by venipuncture. If a significant level of lipid-protein found in the bloodstream leads to a higher risk of cardiovascular disease and stroke.

CPT Code 80061 Summary

CPT code 80061 panel test performs to screen lipid-protein in the bloodstream of the patient’s body Venipuncture retrieves the test samples.

If a significant level of lipid-protein found in the bloodstream leads to a higher risk of cardiovascular disease and stroke, CPT 80061 uses to screen out lipid-protein.

Suppose a patient has Pancreatitis, Liver disease, and CKD (chronic kidney disease) that contributes to raising the level of lipid-protein.

In that case, the CPT code 80061 panel consists of three components (HDL, Triglycerides, Total Cholesterol) and other factors. It would aid in identifying the risks of heart-related diseases. 

The following is the list of symptoms or risks when the Physician orders a CPT 80061 Panel Test:

  • Nausea, vomiting, and Epigastric pain
  • Sweating
  • Headache
  • Toothache, Jaw pain
  • Chest tightness, Body Aches, and Fullness
  • Often Left Arm Pain
  • Hypertension
  • Indigestion and Heartburn etc.
  • Organ related Diseases (CKD, Liver Diseases, Dysfunction of the pancreas, Diabetes)
  • Family history of heart disease

CPT code 80061 approved under CLIA (Clinical Laboratory Improvement Amendments) waived examination.

According to CPT coding guidelines, CPT 80061 bills together with other Panels or organs related diseases if it comprises the same set of tests. Therefore, Modifier QW is applicable. 

According to National Coverage Determination (NCD), there is a list of specific ICD 10 Codes applicable with CPT code 80061 according to National Coverage Determination (NCD).

When CPT code 80061 panel Overlap With other CPT codes, Panel codes will report the more significant number of test CPT, and Separate tests will claim with Individual CPT codes.

CPT Code 80060 Description 

CPT code 80061 bills for service when the Physician performs Lipid panel testing. The following components must include in this panel: 

Cholesterol, serum, total (CPT 82465) 

Lipoprotein, direct measurement, high-density cholesterol (HDL cholesterol) (CPT 83718) 

Triglycerides (CPT 84478) 

Each test reports separately when any component is missing in the panel CPT code 80061.

80061 cpt code

CPT 80061 Reimbursement

The cost of CPT 80061 is as follows according to CMS 2022 payment Schedules:

CPT 80061 without QW modifier ($ 13.39)

CPT 80061 with QW modifier ($ 13.39)

Only 1 unit of CPT code 80061 can bill on the same day. Three are only applicable if medical documentation supports the service as medically necessary.

RVUS is not appropriate for CPT code 80061; Panel CPT 80061 code is only used for coding purposes and does not influence any clinical parameters. It reports only one code (CPT 80061) instead of documenting all the 14 components with different CPT codes.

CPT Code 80061 Modifiers 

The following is the list of modifiers applicable with CPT code 80061:

  • QW, QP, QJ, Q6, Q5, KX, GA, GC, XE, XP, XU, XS, GJ, GK, GR, GU, GX, GY, GZ, ET, EY, CR, CC, AI, 99, 22, 52, 59, 78, 79, 90, 91, 22, 52, 59, 78, 79.

Modifier 90 is appropriate to attach with CPT 80061 when service is performed by other than reporting or treating Physician.

An outside laboratory would process the test. Modifier 59 appends when CPT 80061 is not allowed to be billed together in conjunction with other procedures.

When CPT code 80061 service is Performed more than once or repeated, Modifier 91 appends with CPT code 80061. 

For Example, Patients presented to the hospital with hyperlipidemia. The Physician ordered a laboratory test to rule out the diagnosis Results revealed abnormal laboratory findings.

The Provider treated the diagnosis with medications  Physicians reordered the lab test to check that vitals were better or worse.

Modifier QW is appropriate to append with CPT 80061 as Its CLIA approved waived test.

80061 cpt code description

CPT Code 80061 Billing Guidelines

CPT code 80061 services should be medically necessary and appropriate and do not bundle with other panels codes. 

CPT code 80061 service should be met and regulated under CLIA (1988) for patients’ screening, testing, or treatment purposes.

CPT Code 80061 panel code reports for coding purposes would not affect any clinical condition. It contains three components appropriate to the bill.

All the components are met and performed on the same date of service (DOS) on the same patient by the Same Physician or other qualified healthcare professional.

CPT 80061 bills in two ways:

1st way is to bill as a panel code

2nd way is to bill all the components as individual CPT Codes

All three members of CPT code 80061 do not have any panels. 

Modifier AY is applicable with CPT code 80061 for Medicare Part B services. CPT 80061 is associated with Organ or Disease oriented panels.

When lab and pathology tests are not related to end-stage renal diseases (ESRD) or treatment of ESRD, Modifier AY appends to this type of service provided by the Physician.

Suppose the test specimens retrieve by Venipuncture (like CPT code 36415) in combination with CPT code 80061. In that case, It is appropriate to bill both services separately. 

There is the following list of Place of service (POS) codes that applies to CPT 80061:

Facility POS are 23, 34, 51, 52, 21, 19, 26, 55, 61, 57, while the rest are considered as non-facility POS like 22, 11, etc.

CPT Code 80061 Examples

The following are examples when CPT code 80061 bills:

Example 1

This afternoon, a 34-year-old male with PMH of thyroidectomy (on Synthroid) is here for CP and lightheadedness/HA. The fire alarm went off, and Pt felt chest pain while going downstairs and was lightheaded. Pt states chest pain feels like a tightness has lasted for at least an hour and is still present in the ER. 

Pt has not taken any pain medication at home  Pt denies having had this pain before  PE reveals AOx3. The patient also endorses nausea and lightheadedness, Denies room spinning sensation, Denies SOB, vomiting, fever/chills, fainting, and blood in the stool. 

There are no focal neurological deficits like facial droop or pronator drift  Finger to the nose is negging. Gait is steady and ambulates independently.

Heart exam reveals no m/g/r  CP is not reproducible w/ palpation  Lungs are CTAB. The Physician ordered a Lipid profile test, CMP, EKG, and cardiac monitoring.

Example 2 

77 y/o F, pmh of COPD on nebulizers at home, CABG, aortic valve replacement- 2 valve replacement (bio MVR/AVR 2/2 endocarditis 2015 at Islamabad, L kidney transplant (previously HD with L AFV), HTN, HLD, chronic arthritis, Left hip replacement- 10/19, and asthma, presents with nausea and vomiting black emesis. T

he complication started four days ago. Cannot tolerate solids or liquids PO  Weakness  Denies CP, SOB, hematuria, dysuria, and blood in the stool. 

The Physician ordered multiple tests for a diagnosis like Lipid Panel, CMP, CBC, EKG, and Cardiac Trop. Vitals reveal HTN, 186/73, tachycardic at 100  PE, and generalized abdominal pain to palpation. The heart and lungs are unremarkable.

Example 3

A 61-year-old male with a significant PMH of cholecystectomy, depression, cannabis dependence, and cyclic vomiting presents to the emergency department for vomiting five times from 4 AM until now after smoking one blunt. 

Pt denies bloody emesis, blood in the stool, fever, SOB, CP, bloody stool, and other drug or alcohol use. Pt endorses generalized abdominal discomfort at rest and during palpation. Physicians plan to order multiple Laboratory and pathology tests Like MRI, CT, Lipid profile, CMP, CBC.

Example 4

A 44-year-old female with a PMH of HTN (not on meds for the past month) presents with stroke-like symptoms. The patient states that she noticed that she had difficulty writing while working her job as a security guard, described as being unable to grip the pen properly and feeling like she had to “shake out” her arm. 

She also developed difficulties with a speech around that time, with her coworkers and family members noticing that she was “speaking as if she were drunk”. Symptoms have been constant but waxing and waning in intensity since onset. 

The patient denies new focal weakness or numbness, though she notes that she has right some right leg weakness at baseline. She Denies previously experiencing similar symptoms—the Physician orders series of diagnostic tests, such as a CT head.

Moreover, Pathology, lab tests, CBC, CMP, and Lipid Panel. Anticipate admission for further monitoring, possible neurology evaluation, and likely brain MRI.

Example 5

The patient is a 27-year-old female with no past medical history here with complaints of nausea, vomiting, and diarrhea since last night  States this evening, she is feeling weak and dehydrated. 

She has vomited multiple times today and has been intolerant of solids or liquids  LMP is unknown. She is on OCPs  The patient is not Covid vaccinated  Symptoms are consistent with a viral illness, possibly Covid. 

The patient is tachycardic up to 120s. The Physician will give IV fluids, Zofran, and Pepcid. Furthermore, he ordered Labs panels like CBC, CMP, and Lipid.

Example 6

A 39-year-old male with h/o asthma now for sarcoidosis on chronic prednisone, chronic leukopenia. He is coming in with two days of SOB and chest pain. 

He States it feels similar to his sarcoidosis exacerbation  States he takes 10 mg daily prednisone. Still, He bumps it up to a total of prednisone 20 mg.

He asks to take an extra dose of it whenever he feels his sarcoidosis flaring up. He uses albuterol for his asthma. He used it today, but it did not help the Physician’s plan to order a Lipid profile, MRI, and CT.

Example 7

This afternoon, a 34-year-old male with PMH of thyroidectomy (on Synthroid) is here for CP and lightheadedness/HA. The fire alarm went off, and Pt felt chest pain while going downstairs and was lightheaded.

Pt states chest pain feels like a tightness has lasted for at least an hour and is still present in the ER.

The patient also endorses nausea and lightheadedness. The patient denies the room spinning sensation.

Denies SOB, vomiting, fever/chills, fainting, blood in the stool. Pt has not taken any pain medication at home. Pt denies having had this pain before. PE reveals AOx3. No focal neurological deficits like facial droop or pronator drift.

Finger to the nose is negging. Gait is steady and ambulates independently. Heart exam reveals no m/g/r. CP is not reproducible w/ palpation. Lungs are CTAB. The physician ordered a Lipid profile test, CMP, EKG, and cardiac monitoring.

Example 8

77 y/o F, PMH of COPD on nebulizers at home, CABG, aortic valve replacement- 2 valve replacement (bio MVR/AVR 2/2 endocarditis 2015 at Islamabad, L kidney transplant (previously HD with L AFV), HTN, HLD, chronic arthritis, Left hip replacement- 10/19, and asthma, presents with nausea and vomiting black emesis.

Symptoms started four days ago. Cannot tolerate solids or liquids PO. Weakness. Denies CP, SOB, hematuria, dysuria, blood in the stool. The physician ordered multiple tests for a diagnosis like Lipid Panel, CMP, CBC, EKG, Cardiac Trop. 

Vitals reveal HTN, 186/73, tachycardic at 100. PE reveals generalized abdominal pain to palpation. Heart and lungs unremarkable.

Example 9

The patient is a 39-year-old male with a significant PMH of cholecystectomy, depression, cannabis dependence, cyclic vomiting who presents to the emergency department for vomiting five times from 4 AM until now after smoking one blunt.

Pt denies bloody emesis blood in the stool. Pt endorses generalized abdominal discomfort at rest and during palpation. The patient denies fever, SOB, CP, bloody stool. They also deny other drug or alcohol use.

Physician’s plan is to order multiple Laboratory and pathology tests Like MRI, CT, Lipid profile, CMP, CBC

cpt codes 80061

Example 10

A 44-year-old female with a PMH of HTN (not on meds for the past month) presents with stroke-like symptoms.

The patient states that she noticed that she had difficulty writing while working her job as a security guard, described as being unable to properly grip the pen and feeling like she had to “shake out” her arm.

She also developed difficulties with a speech around that time, with her coworkers and family members noticing that she was “speaking as if she were drunk .”Symptoms have been constant but waxing and waning in intensity since onset.

The patient denies new focal weakness or numbness, though she notes that she has right some right leg weakness at baseline. The patient denies previously experiencing similar symptoms.

Physician ordered to obtain CT head, Pathology and lab test CBC, CMP, Lipid Panel. Anticipate admission for further monitoring, possible neurology evaluation, and possible brain MRI.

Example 11

The patient is a 27-year-old female with no past medical history and complaints of nausea, vomiting, diarrhea since last night. States this evening, she is feeling weak and dehydrated.

She has vomited multiple times today and has been intolerant of solids or liquids. LMP not known she is on OCPs. The patient is not Covid vaccinated.

Symptoms are consistent with a viral illness, possibly Covid. The tachycardic patient up to 120s will give IV fluids, Zofran, Pepcid. Labs panels were ordered like CBC, CMP, Lipid.

Example 12

A 39-year-old male with h/o asthma, who has never been admitted or intubated for this, weather changes and fumes are triggered.

He notes they are painting in his building right now, which has made things worse, sarcoidosis on chronic prednisone chronic leukopenia.

He is coming in with two days of sob and chest pain. States it feels similar to his sarcoidosis exacerbation.

He states he takes 10 mg daily prednisone but bumps it up to a total of 20 mg because he was told to take an extra dose whenever he feels his sarcoidosis flaring up.

He uses albuterol for his asthma, and he used it today, but it did not help. The physician plans to order a Lipid profile, MRI, CT.

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