CPT Code for Medicare Lipid Panel Coverage
Medicare covers lipid panel testing using CPT code 80061, which includes measurement of total cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol.
Standard Lipid Panel Components
The comprehensive lipid profile covered by Medicare includes 1, 2:
- Total cholesterol
- LDL cholesterol (calculated or direct)
- HDL cholesterol
- Triglycerides
CPT Code 80061 Specifications
CPT code 80061 is the standard code for a complete lipid panel that encompasses all four measurements listed above 1. This code is recognized by Medicare for reimbursement when medically necessary.
Fasting vs. Non-Fasting Samples
- Either fasting or non-fasting samples are acceptable for initial lipid assessment and cardiovascular risk estimation in adults 1, 2
- If non-fasting triglycerides are ≥400 mg/dL (≥4.5 mmol/L), a repeat fasting lipid profile should be obtained for accurate assessment 1
- Non-fasting samples provide sufficient accuracy for most clinical decision-making regarding cardiovascular risk 1
Medicare Coverage Frequency
Based on guideline recommendations that inform Medicare coverage policies 1:
- Initial screening: Recommended for all adults ≥20 years of age
- Routine monitoring: Every 5 years for patients with normal lipid profiles and low cardiovascular risk 1, 2
- More frequent testing (every 3-12 months) is appropriate for patients on lipid-lowering therapy or those with established cardiovascular disease 1
Additional Testing Considerations
While not part of the standard CPT 80061 panel, non-HDL cholesterol (calculated as total cholesterol minus HDL cholesterol) is an important secondary parameter that requires no additional testing or cost 2, 3. This value is automatically available from the standard lipid panel results.
Common Pitfalls to Avoid
- Do not use CPT 80061 for individual lipid component testing - separate codes exist for single analyte measurements
- Ensure medical necessity documentation is present in the patient record to support Medicare coverage
- For LDL-C <70 mg/dL (<1.8 mmol/L), direct LDL-C measurement may be more accurate than the Friedewald calculation, though this may require a different CPT code 1, 2