This Policy version was replaced on October 28, 2024. To find the newest version, go to https://www.bluecrossmn.com/providers/medical-management, select 'See Medical and Behavioral Health Policies', then 'Blue Cross and Blue Shield of Minnesota Medical and Behavioral Health Policies'. This will bring up the Medical Policy search screen. Enter the policy number without the version number (last three digits).
Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) are considered major risk factors for cardiovascular disease (CVD); however, they do not completely predict risk of disease. Only a minority of individuals with elevated LDL and cholesterol levels will develop clinical disease, and up to 50% of cases of coronary artery disease (CAD) occur in people with normal levels of total and LDL cholesterol (LDL-C). Because of this, there is interest in determining whether measurement of non-traditional lipid or nonlipid biomarkers may improve the accuracy of current cardiovascular risk prediction models. Some of these biomarkers are also being evaluated for their potential utility in monitoring response to CVD treatment or as targets for treatment
Measurement of the following lipid or nonlipid biomarkers for risk assessment and/or management of cardiovascular disease is considered EXPERIMENTAL/INVESTIGATIVE because these measurements have not been shown to provide clinical benefit beyond that provided by traditional lipid panels and therapies:
0052U 82172 82610 83090 83695 83698 83700 83701 83704 85384 85385
No additional statements.
Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.
Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.
Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites.
Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement.
These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
