Coding Information

Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 999 Not Applicable CPT/HCPCS Codes: Group 1 Paragraph: The following CPT® codes are covered: Group 1 CPT Codes: 82172 APOLIPOPROTEIN, EACH 82610 CYSTATIN C 83090 HOMOCYSTEINE 83695 LIPOPROTEIN (A) 83698 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2) 83700 LIPOPROTEIN, BLOOD; ELECTROPHORETIC SEPARATION AND QUANTITATION 83701 LIPOPROTEIN, BLOOD; HIGH RESOLUTION FRACTIONATION AND QUANTITATION OF LIPOPROTEINS INCLUDING LIPOPROTEIN SUBCLASSES WHEN PERFORMED (EG, ELECTROPHORESIS, ULTRACENTRIFUGATION) 83704 LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S) (EG, BY NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY), INCLUDES LIPOPROTEIN PARTICLE SUBCLASS(ES), WHEN PERFORMED 83719 LIPOPROTEIN, DIRECT MEASUREMENT; VLDL CHOLESTEROL 83721 LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL 86141 C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP) ICD-10 Codes That Are Covered The following ICD-10 codes are covered: E71.30 Disorder of fatty-acid metabolism, unspecified E75.21 Fabry (-Anderson) disease E75.22 Gaucher disease E75.240 Niemann-Pick disease type A E75.241 Niemann-Pick disease type B E75.242 Niemann-Pick disease type C E75.243 Niemann-Pick disease type D E75.244 Niemann-Pick disease type A/B E75.248 Other Niemann-Pick disease E75.249 Niemann-Pick disease, unspecified E75.3 Sphingolipidosis, unspecified E75.5 Other lipid storage disorders E75.6 Lipid storage disorder, unspecified E77.0 Defects in post-translational modification of lysosomal enzymes E77.8 Other disorders of glycoprotein metabolism E77.9 Disorder of glycoprotein metabolism, unspecified E78.00 Pure hypercholesterolemia, unspecified E78.01 Familial hypercholesterolemia E78.1 Pure hyperglyceridemia E78.2 Mixed hyperlipidemia E78.3 Hyperchylomicronemia E78.41 Elevated Lipoprotein(a) E78.49 Other hyperlipidemia E78.5 Hyperlipidemia, unspecified E78.70 Disorder of bile acid and cholesterol metabolism, unspecified E78.79 Other disorders of bile acid and cholesterol metabolism E78.81 Lipoid dermatoarthritis E78.89 Other lipoprotein metabolism disorders E78.9 Disorder of lipoprotein metabolism, unspecified E88.1 Lipodystrophy, not elsewhere classified E88.2 Lipomatosis, not elsewhere classified E88.89 Other specified metabolic disorders I10 Essential (primary) hypertension I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris I42.0 Dilated cardiomyopathy I48.11 Longstanding persistent atrial fibrillation I48.19 Other persistent atrial fibrillation I48.20 Chronic atrial fibrillation, unspecified I48.21 Permanent atrial fibrillation I51.9 Heart disease, unspecified I52 Other heart disorders in diseases classified elsewhere I63.011 Cerebral infarction due to thrombosis of right vertebral artery I63.012 Cerebral infarction due to thrombosis of left vertebral artery I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries I63.02 Cerebral infarction due to thrombosis of basilar artery I63.031 Cerebral infarction due to thrombosis of right carotid artery I63.032 Cerebral infarction due to thrombosis of left carotid artery I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries I63.09 Cerebral infarction due to thrombosis of other precerebral artery I63.111 Cerebral infarction due to embolism of right vertebral artery I63.112 Cerebral infarction due to embolism of left vertebral artery I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries I63.12 Cerebral infarction due to embolism of basilar artery I63.131 Cerebral infarction due to embolism of right carotid artery I63.132 Cerebral infarction due to embolism of left carotid artery I63.133 Cerebral infarction due to embolism of bilateral carotid arteries I63.19 Cerebral infarction due to embolism of other precerebral artery I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries I63.341 Cerebral infarction due to thrombosis of right cerebellar artery I63.342 Cerebral infarction due to thrombosis of left cerebellar artery I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries I63.39 Cerebral infarction due to thrombosis of other cerebral artery I63.411 Cerebral infarction due to embolism of right middle cerebral artery I63.412 Cerebral infarction due to embolism of left middle cerebral artery I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries I63.421 Cerebral infarction due to embolism of right anterior cerebral artery I63.422 Cerebral infarction due to embolism of left anterior cerebral artery I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries I63.431 Cerebral infarction due to embolism of right posterior cerebral artery I63.432 Cerebral infarction due to embolism of left posterior cerebral artery I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries I63.441 Cerebral infarction due to embolism of right cerebellar artery I63.442 Cerebral infarction due to embolism of left cerebellar artery I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries I63.49 Cerebral infarction due to embolism of other cerebral artery I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery I63.81 Other cerebral infarction due to occlusion or stenosis of small artery I63.89 Other cerebral infarction I63.9 Cerebral infarction, unspecified I67.858 Other hereditary cerebrovascular disease I70.0 Atherosclerosis of aorta I70.1 Atherosclerosis of renal artery I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs I70.208 Unspecified atherosclerosis of native arteries of extremities, other extremity I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg I70.25 Atherosclerosis of native arteries of other extremities with ulceration I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity I70.291 Other atherosclerosis of native arteries of extremities, right leg I70.292 Other atherosclerosis of native arteries of extremities, left leg I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs I70.298 Other atherosclerosis of native arteries of extremities, other extremity I70.301 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg I70.302 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg I70.303 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs I70.308 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity I70.321 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg I70.322 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg I70.323 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs I70.328 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, other extremity I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot I70.8 Atherosclerosis of other arteries I70.90 Unspecified atherosclerosis I70.91 Generalized atherosclerosis I70.92 Chronic total occlusion of artery of the extremities R00.2 Palpitations R07.1 Chest pain on breathing R07.2 Precordial pain R07.82 Intercostal pain R07.89 Other chest pain R07.9 Chest pain, unspecified Z13.6 Encounter for screening for cardiovascular disorders Z86.711 Personal history of pulmonary embolism Z86.718 Personal history of other venous thrombosis and embolism Z86.72 Personal history of thrombophlebitis Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits Z86.74 Personal history of sudden cardiac arrest Z86.79 Personal history of other diseases of the circulatory system ICD-10 Codes That Are Not Covered N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation 01/01/2023 R6 Updated to indicate this article is an LCD Reference Article. 01/01/2023 R5 Under CPT/HCPCS Codes Group 1: Codes the description was revised for 83090. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is effective for dates of service on or after 1/1/2023. 10/01/2021 R4 Revision History Typographical error - I63.039 was removed not I63.09.  10/01/2021 R3 10/01/2021: Typographical error - removal of I63.09 missed in last update. 10/01/2021 R2 Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted I48.91, I63.00, I63.019, I63.039, I63.10, I63.119, I63.139, I63.20, I63.219, I63.239, I63.30, I63.319, I63.329, I63.339, I63.349, I63.40, I63.419, I63.429, I63.439, I63.449, I63.50, I63.519, I63.529, I63.539, I63.549, I70.209, I70.219, I70.229, I70.239, I70.249, I70.269, I70.299, I70.309, I70.319, I70.329. This revision will become effective 10/1/21. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added E75.244. This revision is due to the Annual ICD-10 update and is effective on 10/1/21. Under Article Text: Removal of claim information. 10/01/2019 R1 10/01/2019: This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related MolDX: Biomarkers in Cardiovascular Risk Assessment LCD and placed in this article.