CPT 4 Codes – Billing News

Effective for dates of service on or after May 1, 2008, CPT-4 codes 80061 (lipid panel test) and 83721 (LDL cholesterol test) may not both be reimbursed on the same date of service, for the same recipient, and by the same rendering provider unless the triglyceride level of the recipient is greater than 400 mg/dl.

This triglyceride level value must be entered in the Remarks field (Box 80)/Reserved for Local Use field ( Box 19) of the claim form. In addition, both CPT-4 codes must be billed on the same claim form in order for providers to receive reimbursement for codes 80061 and 83721 on the same date of service. If the triglyceride level of the recipient is less than 400 mg/dl and both CPT-4 codes 80061 and 83721 are billed on the same date of service, for the same recipient, and by the same rendering provider, only code 80061 will be reimbursed.