Thursday, March 20, 2008

Medicare covers cardiovascular screening blood tests

February is American Heart Month and I know it's now March but I feel that this is important to blog about this topic. Did you know that the Number 1 cause for death in the united states is Heart Disease? The 3rd cause of death is stroke.

So as a patient what are your options to identifying if you are at risk? The next time you are in the office with your doctor ask them to take blood work to compare your #'s to the ones below.

* Total Cholesterol Test
* Cholesterol Test for High-density Lipoproteins
* Triglycerides Test

Lets break these tests down to identify good results vs. high risk results.

The Total Cholesterol Test Results
Desirable: Under 200 milligrams per deciliter (mg/dL)
Borderline high: 200 to 239 mg/dL
High risk: 240 mg/dL and higher

Cholesterol Test for High-density Lipoproteins (you want to score high on this test)
Desirable: An HDL 60 mg/dL or above helps protect against heart disease
High Risk: Men that score 37 mg/dL or Women that score below 47 mg/dL

Triglycerides Test
Desirable: based on a fasting level of under 150 mg/dL
Borderline high: 150-199 mg/dl
High: 200-499 mg/dL
High Risk: 500 mg/dL or higher

It is recommended to begin testing for the Triglycerides Test at age 20 and again every 5 years. If you are over the age of 40 it is recommended to increase the testing to once a year and for Diabetics every 3 months.

If you are a Medicare B patient these three tests are covered by Medicare at 100%. For other patients call your health insurance plans to identify if these are covered services for you.

At this point I would like to wrap this up by saying it's your heart and your life. You deserve to live long and live in good health. Here are some healthy suggestions to keep your heart risks low:

*Maintain annual check ups with your health care provider and talk to them about your health
*eat real food products that are minimially processed *excercise 40 minutes a day (20 before breakfast and 20 before dinner)
*drink 8 glasses of water
*chew your food until it becomes liquid in your mouth then swallow
*eat when you are not distracted like watching TV or being on a computer
*cut back on the salt and use pepper or garlic lemon pepper for flavor
*Remove chemicals from your diet like Autolyzed Yeast, Autolyzed Yeast Extract, MSG, Monosodium Glutamate) This includes Campbells Soup and Swansons Broth ~ read the labels
*Add flaxseed or flaxseed oil to your diet
*Add trace minerals like "Real" salt (

*If you are the daring type try Colonix once a year - my husband and I do this every year and it really does work (

Here's to wishing you a happy, long prosperous lifestyle.

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  1. Hello. Love your blog! Just came across it on a Google search for a Medicare Denial code and starting browsing some of your topics. Great website!

    Anyhow, we are an independent pharmacy with DME, hence we bill for Part B items (including Flu Shots). We recently were set up to administer cholesterol screenings. Can a pharmacy/DME bill Medicare B for cholesterol screenings or does it have to be done in a physician office for covereage?


  2. Hi Jason,

    Thanks for your comments! I have been billing and collecting for over 12 years and love this stuff. When I have time I like to add my thoughts to my blog.

    I hope this helps answer your question!

    Q: Can a pharmacy/DME bill Medicare B for Cholesterol screenings?
    A: Cholesterol Screenings must be provided by a Physician or technologists under RESPONSIBLE supervision of a Physician. Part B claims are billed on a CMS-1500 form or electronically billed to Medicare as a Professional Claim.

    If you are a pharmacy think of how the bigger chains are doing this: They have providers contracted out to come to their facility certain hours of the day to perform the Cholesterol Screenings. I would recommend researching these options. I am also guessing you already have Practice Management Software to bill your CMS-1500 claims for the DME/Flu Shot codes.

    Other Helpful Billing Tips for Cholesterol Screenings in accordance with Section 612 of the Medicare Modernization Act:

    The MMA permits coverage of tests for cholesterol and other lipid triglycerides levels for the purpose of early detection of cardiovascular disease or abnormalities associated with elevated risk for that disease.

    A patient covered under Medicare can have a Cholesterol Screening test performed once every 5 Years. Because older peoples Lipid and Cholesterol levels remain fairly consistent this test isn't needed often.

    Medicare will cover the screening blood tests when ordered by a physician who is treating the patient for the purpose of early detection of cardiovascular disease in patients that do not have apparent signs or symptoms (i.e. risk because of diet or lack of exercise but no known knowledge of heart issues).

    No Deductible or copayment for these services. Payment is provided under the Medicare Clinical Laboratory Fee Schedule.

    Procedure Codes and Diagnosis Codes covered:
    80061 Lipid Panel
    82465 Cholesterol, Serum or whole blood, total
    83718 Lipoprotein, direct measurement; high-density cholesterol
    84478 Triglycerides

    Medicare asks that when possible you perform the tests as the 80061 Lipid Panel but individual testing is all OK. Normally you should be billing 80061.

    Diagnosis codes:
    V81.0 Special Screening for ischemic heart disease
    V81.1 Special Screening for hypertension
    V81.2 Special Screening for other and unspecified cardiovascular conditions.

    To protect yourself: Have each patient sign the most recent ABN form to secure payment if Medicare doesn't pay. If they identify the patient has already been treated within the last 59 months by another facility you will get a denial on your claim.

    As of April 1st 2005 Medicare added a edit to scrub claims and verify the patient has not been treated for any of these procedure codes within the last 59 months. It is specifically looking for referred clinical diagnostic laboratory services and purchased diagnostic services submitted by physicians/suppliers to more than one carrier.

    Key Words: How to bill for Cholesterol Screening Tests, Physician billing, Medical Billing, Denial, ABN form, Lipid Panel, 80061, Cholesterol Screening, 82465, Lipoprotein 83717, 84478 Triglycerides, 59 month, 5 years, Medicare billing, Claim Denials