Preventive Services

Preventive Services Guide


Cardiovascular Disease Screening Tests

Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

Table of Contents

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Coverage Criteria

All Medicare beneficiaries without apparent signs or symptoms of CVD are covered.

  • Once every five years
    • At least 59 months must have passed from the last covered screening test

Must be ordered by a physician or qualified NPP for CVD early detection. CVD risk factors include:

  • Diabetes
  • Family history of cardiovascular disease
  • Diets high in saturated fats, cholesterol and salt or sodium
  • History of previous heart disease
  • Hypercholesterolemia (high cholesterol)
  • Hypertension
  • Lack of exercise
  • Obesity
  • Excessive alcohol use
  • Smoking
  • Stress

Beneficiary must fast for 12 hours prior to testing for the following covered tests:

  • Total cholesterol
  • Cholesterol test for high-density lipoproteins
  • Triglycerides test

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HCPCS/CPT Coding

  • 82465: Cholesterol, serum or whole blood, total
  • 83718: Lipoprotein, direct measurement; HDL cholesterol
  • 84478: Triglycerides
  • 80061: Lipid Panel (must include 82465, 83718 and 84478)

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Diagnosis Coding

  • ICD-10 Codes
    • Z13.6
  • Note: Additional ICD-10 codes may apply. See the CMS ICD-10 webpage for individual CRs and the specific ICD-10-CM codes Medicare covers for this service and contact your MAC for guidance.

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Who Can Perform?

  • Physician: doctor of medicine or osteopathy
  • Qualified NPP

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Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

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Reimbursement

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Nonparticipating Providers

  • Nonparticipating reduction applies
  • Limiting charge provision applies

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Common Claim Denials

  • Beneficiary received a covered lipid panel during past five years
  • Beneficiary received same individual cardiovascular screening test(s) within past five years

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Related Content

Reviewed 9/27/2024