Cholesterol Screening (Lipid Disorders Screening)

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/preventive-care-services.pdf

Service:

USPSTF: United States Preventative Services Task Force

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for all adults aged 40 to 75 years who have 1 or CVD risk factors (I.e. dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of cardiovascular event of 10% or greater.

Notes:

• For statin medications benefits refer to the pharmacy plan administrator

• See Dyslipidemia Screening (Bright Futures) for recommendations for children.

Procedure Code(s):

Cholesterol Screening:

80061, 82465, 83718, 83719, 83721, 83722, 84478

Blood Draw:

36415, 36416

ASCVD Risk Assessment and Risk Management Services:

G0537, G0538

Diagnosis Code(s):

Z00.00, Z00.01, Z13.220

Preventative Benefit Instructions:

Cholesterol Screening:

Ages 40-75 (ends on the 76th birthday)

Requires one of the diagnosis codes listed above for 80061, 82465, 83718, 83719, 83721, 83722, 84478.

Blood Draw:

Ages 40-75 years (ends on 76th birthday): Requires on of the listed Cholesterol Screening procedure codes andone of the Diagnosis Codes listed above.

ASCVD Risk Assessment and Management Services:

Ages 40-75 years (ends on 76th birthday). The diagnosis codes listed above are not required for G0537 and G0538.

Preventive Benefit Does Not Apply:

For all ages above, if any of the following lipid disorders diagnosis codes are present in any position, the preventative benefit does not apply:

E71.30, E75.5, E78.00, E78.01, E78.2, E78.3, E78.41, E78.49, E78.5, E78.79, E78.81, E78.89, E88.2, E88.89