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Coverage criteria policies

Cardiovascular risk assessments

These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization.

Indications that are covered

Standard, accepted risk assessment approaches including medical history; assessment of diet and smoking; and measurement of cholesterol/low density lipoprotein levels (simple lipid panel).

Indications that are not covered include, but are not limited to

  1. Routine screening with resting electrocardiogram (ECG) or exercise tread mill test (ETT).
  2. Expanded cardiovascular risk panels are considered investigational in determining cardiovascular risk or managing cardiovascular risk due to the lack of clinical evidence demonstrating the impact of these tests on improved health outcomes.
  3. The following specific tests are considered experimental investigational in determining cardiovascular risk or managing cardiovascular disease: (this list is not all inclusive)
    1. High Sensitive C-reactive protein testing
    2. Homocysteine testing
    3. Lipoprotein-associated phospholipase A2 (Lp-PLA2)
    4. B-type Natriuretic peptide
    5. Cystatin C
    6. Fibrinogen
    7. Leptin
    8. Lipoprotein high resolution fractionation and quantitation
    9. Quantitation of lipoprotein particle numbers and lipoprotein particles subclasses
    10. Common carotid intima-media thickness testing
    11. Non-invasive methods to evaluate endothelial function by peripheral artery tonometry (e.g.EndoPAT)
    12. Non-invasive measurements of arterial elasticity using blood pressure waveforms (e.g., HDI PulseWave, CVProfilor)
    13. NMR LipoProfile ® Test

Definitions

Expanded Cardiovascular Risk Panel: These are composed of multiple individual markers and/or measures intended to assess cardiac risk, other than simple lipid panels. These additional tests fall into several general categories, including lipid markers, non-lipid markers, radiologic measures, inflammatory measures, metabolic parameters, and genetic markers. Some expanded cardiovascular risk panels are relatively limited, and include only a few markers in addition to standard lipid panel. Others expanded risk panels include a wide variety of tests from a number of different categories, often including both genetic and non-genetic tests. Other panels are composed entirely of genetic markers. The expanded risk panel therefore reports the results of multiple individual tests, in contrast to quantitative risk scores which combine the results of multiple markers into one score. While the individual risk factors have in most cases been associated with increased risk of cardiovascular disease, it is not clear how the results of individual risk factors impact management changes, so it is also not certain how the panels will impact management decisions. Given the lack of evidence for clinical utility of any individual risk factor beyond simple lipid measures, it is unlikely that the use of cardiovascular risk panels improve outcome.

Simple lipid panel is usually composed of the following standard lipid measures: total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Certain calculated ratios, such as the total/HDL cholesterol may be reported as part of a simple lipid panel. Other types of lipid testing are not considered to be components of a simple lipid panel. Simple lipid panel is medically necessary for prediction of risk for coronary artery disease.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

82163

Angiotensin II

82172

Apolipoprotein, each

82306

Vitamin D25 Hydroxy

82397

Chemiluminescent assay

82541

Column chromatography/mass spectromoetry; qual

82542

Column chromatography/mass spectromoetry; quant

82544

Column chromatography/mass spectromoetry; stable isotope dilution, multiple analytes, quant

82610

Cystatin C

82652

Vitamin D; 1,25 dihydroxy, includes fraction(s), if performed

82725

Assay of blood fatty acids

82726

Very long chain fatty acids

83036

Glycosylated hemoglobin test

83090

Homocysteine

83520

Immunoassay quant nos nonab

83525

Assay of insulin

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 (e.g., electrophoresis, ultracentrifugation)

83704

Lipoprotein, blood; quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., by nuclear magnetic resonance spectroscopy)

83719

Lipoprotein, direct measurement; VLDL cholesterol

83876

Assay myeloperoxidase

83880

Natriuretic peptide

85230

Clotting; factor VII (proconvertin, stable factor)

85247

Clotting; factor VIII, von Willebrand factor, multimetric analysis

85300

Clotting inhibitors or anticoagulants; antithrombin III, activity

85303

Clotting inhibitors or anticoagulants; protein C, activity

85384

Fibrinogen; activity

85385

Fibrinogen; antigen

84999

Unlisted chemistry procedure

85415

Fibrinolytic factors and inhibitors; plasminogen activator

85420

Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay

85421

Fibrinolytic factors and inhibitors; plasminogen, antigenic assay

86141

High sensitivity C-reactive protein

93799

Unlisted cardiovascular service or procedure – (Endo-PAT2000 System)

0126T

Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

References

  1. Di Angelantonio E, Chowdhury R, Sarwar N, et al. B-type natriuretic peptides and cardiovascular risk: Systematic Review and Meta-analysis of 40 Prospective Studies. Circulation. 2009;120(22):2177-2187.
  2. ECRI Institute. (2014) Health Technology Assessment. NMR LipoProfile Test for Predicting Cardiovascular Disease Risk. Plymouth Meeting, PA: ECRI Institute.
  3. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: Genomic profiling to assess cardiovascular risk to improve cardiovascular health. Genetics in Medicine. 2010: 12(12) 839-842.
  4. Goff, D.C Jr., Lloyd-Jones, D.M., Bennett,G., et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(suppl 2):S49-S73
  5. Hayes, Inc. Hayes Genetic Test Evaluation Report. Fibrinogen-Beta (FGB) c.-455G>A Polymorphism Testing in Cardiovascular Disease.Lansdale, PA: Hayes, Inc.; August, 2012. Reviewed July 2016.
  6. Hayes, Inc. Hayes Medical Technology Directory Report. Lipoprotein-Associated Phospholipase Testing for Coronary Heart Disease Risk Assessment in Healthy or Asymptomatic Adults. Lansdale, PA: Hayes, Inc.; December, 2010. Reviewed October 2015. Archived January, 2016.
  7. Hayes, Inc. Hayes Medical Technology Directory Report. Measurement of carotid intima-media thickness for prediction of clinical vascular events. Lansdale, PA: Hayes, Inc.; July, 2009. Reviewed July, 2013. Archived August, 2014.
  8. Helfand, M; Buckley, D.I., Freeman, M., et al. “Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force.” Ann Intern Med. 2009;151:496-507.
  9. Moll, S., & Varga, E. A. (2015). Homocysteine and MTHFR mutations. Circulation132(1), e6–e9. 
  10. Morrow, D.A. Screening for cardiovascular risk with C-reactive protein. In: UpToDate.Kaski, J.C. (Ed), UpToDate, Waltham, MA. (Accessed on October 31, 2016).
  11. Ndrepepa G, Braun S, King L, et al. Relation of fibrinogen level with cardiovascular events in patients with coronary artery disease. Am J Cardiol. 2013 Mar 15;111(6):804-10.
  12. The Emerging Risk Factors Collaboration*. Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular Mortality. JAMA. 2009;302(4):412-423.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. This information is not the same for Medicare. If you have questions or would like help, please call Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 06/03/2010 - Date of origin
  • 12/01/2016 - Effective date
Review date
  • 12/2016

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