Cardiovascular Screening Blood Test Guidelines

Medicare provides coverage for the cardiovascular screening blood test for beneficiaries every five years (i.e., 59 months after the last covered screening tests.) Medicare has determined that it is not necessary to test more frequently since lipid and cholesterol levels for people often stay fairly consistent beyond age 65.

The implementation of this new benefit permits Medicare beneficiaries who have not been previously diagnosed with cardiovascular disease to receive cardiovascular screening blood tests for risk factors associated with cardiovascular disease. This includes individuals who have no prior knowledge of heart problems but recognize that their behavior or lifestyle may be at risk because of diet or lack of exercise.

The following HCPCS/CPT Codes are to be billed for the Cardiovascular Screening Blood Tests:

• 80061 Lipid Panel
• 82465 Cholesterol, serum, or whole blood, total
• 83718 Lipoprotein, direct measurement; high-density cholesterol
• 84478 Triglycerides

(The tests should be performed as a panel; however, they are also available as individual tests.) The following diagnosis codes must be submitted on the claim when billing for cardiovascular screening blood test:

• V81.0 Special Screening for ischemic heart disease
• V81.1 Special Screening for hypertension
• V81.2 Special Screening for other and unspecified cardiovascular conditions

Carriers/intermediaries will deny claims with code 80061 when there is already evidence of a paid claim within the prior 60 months that was billed with a diagnosis code of V81.0, V81.1, or V81.2, and with a procedure code of 80061, 82465, 83718, or 84478.