**

Indications

**

The medical community recognizes lipid testing as appropriate for evaluating
atherosclerotic cardiovascular disease. Conditions in which lipid testing may
be indicated include:

  * Assessment of patients with atherosclerotic cardiovascular disease.
  * Evaluation of primary dyslipidemia.
  * Any form of atherosclerotic disease, or any disease leading to the formation of atherosclerotic disease.
  * Diagnostic evaluation of diseases associated with altered lipid metabolism, such as: nephrotic syndrome, pancreatitis, hepatic disease, and hypo and hyperthyroidism.
  * Secondary dyslipidemia, including diabetes mellitus, disorders of gastrointestinal absorption, chronic renal failure.
  * Signs or symptoms of dyslipidemias, such as skin lesions.
  * As follow-up to the initial screen for coronary heart disease (total cholesterol + HDL cholesterol) when total cholesterol is determined to be high (>240 mg/dL), or borderline-high (200-240 mg/dL) plus two or more coronary heart disease risk factors, or an HDL cholesterol, <35 mg/dl.

To monitor the progress of patients on anti-lipid dietary management and
pharmacologic therapy for the treatment of elevated blood lipid disorders,
total cholesterol, HDL cholesterol and LDL cholesterol may be used.
Triglycerides may be obtained if this lipid fraction is also elevated or if
the patient is put on drugs (for example, thiazide diuretics, beta blockers,
estrogens, glucocorticoids, and tamoxifen) which may raise the triglyceride
level.

When monitoring long term anti-lipid dietary or pharmacologic therapy and when
following patients with borderline high total or LDL cholesterol levels, it
may be reasonable to perform the lipid panel annually. A lipid panel at a
yearly interval will usually be adequate while measurement of the serum total
cholesterol or a measured LDL should suffice for interim visits if the patient
does not have hypertriglyceridemia.

Any one component of the panel or a measured LDL may be reasonable and
necessary up to six times the first year for monitoring dietary or
pharmacologic therapy. More frequent total cholesterol HDL cholesterol, LDL
cholesterol and triglyceride testing may be indicated for marked elevations or
for changes to anti-lipid therapy due to inadequate initial patient response
to dietary or pharmacologic therapy. The LDL cholesterol or total cholesterol
may be measured three times yearly after treatment goals have been achieved.

Electrophoretic or other quantitation of lipoproteins may be indicated if the
patient has a primary disorder of lipoid metabolism.

Effective January 1, 2005, the Medicare law expanded coverage to
cardiovascular screening services. Several of the procedures included in this
NCD may be covered for screening purposes subject to specified frequencies.
See 42 CFR 410.17 and section 100, chapter 18, of the [Claims Processing
Manual](https://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-
Items/CMS018912.html?DLPage=1&DLSort=0&DLSortDir=ascending), for a full
description of this benefit.

**

Limitations

**

Lipid panel and hepatic panel testing may be used for patients with severe
psoriasis which has not responded to conventional therapy and for which the
retinoid etretinate has been prescribed and who have developed hyperlipidemia
or hepatic toxicity. Specific examples include erythrodermia and generalized
pustular type and psoriasis associated with arthritis.

Routine screening and prophylactic testing for lipid disorder are not covered
by Medicare. While lipid screening may be medically appropriate, Medicare by
statute does not pay for it. Lipid testing in asymptomatic individuals is
considered to be screening regardless of the presence of other risk factors
such as family history, tobacco use, etc.

Once a diagnosis is established, one or several specific tests are usually
adequate for monitoring the course of the disease. Less specific diagnoses
(for example, other chest pain) alone do not support medical necessity of
these tests.

When monitoring long term anti-lipid dietary or pharmacologic therapy and when
following patients with borderline high total or LDL cholesterol levels, it is
reasonable to perform the lipid panel annually. A lipid panel at a yearly
interval will usually be adequate while measurement of the serum total
cholesterol or a measured LDL should suffice for interim visits if the patient
does not have hypertriglyceridemia.

Any one component of the panel or a measured LDL may be medically necessary up
to six times the first year for monitoring dietary or pharmacologic therapy.
More frequent total cholesterol HDL cholesterol, LDL cholesterol and
triglyceride testing may be indicated for marked elevations or for changes to
anti-lipid therapy due to inadequate initial patient response to dietary or
pharmacologic therapy. The LDL cholesterol or total cholesterol may be
measured three times yearly after treatment goals have been achieved.

If no dietary or pharmacological therapy is advised, monitoring is not
necessary.

When evaluating non-specific chronic abnormalities of the liver (for example,
elevations of transaminase, alkaline phosphatase, abnormal imaging studies,
etc.), a lipid panel would generally not be indicated more than twice per
year.

Note: Scroll down for links to the quarterly Covered Code Lists (including
narrative).