Cardiovascular Disease Screening – Lipid Blood Testing

The Centers for Medicare and Medicaid Services (CMS) allows Cardiovascular Disease Screening once every five years for beneficiaries without apparent cardiovascular disease signs or symptoms using ICD-10 code Z13.6 (special screening examination for cardiovascular disorders).

For asymptomatic persons, submit Z13.6 ONLY without any other diagnosis codes with the lipid test procedure codes listed below for preventive screening once every five years

  • Use of ICD-10 code Z13.6 more frequently than once every five years will result in claim rejection and member cost liability

For lipid testing related to disease monitoring, submit the claim WITHOUT Z13.6 and with one or more disease diagnosis codes with the procedure codes listed below.

Lipid panel (80061) must include the following:

  • Cholesterol, serum, total (82465)
  • Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718)
  • Triglycerides (84478)