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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

Prior authorization is not required for cardiovascular risk assessment.

Coverage

  • Simple lipid panel is generally covered subject to the indications listed below and per your plan documents.
  • Expanded cardiovascular risk panels are considered investigational/experimental and are therefore not covered.

Indications that are covered

  1. Standard, accepted risk assessment approaches for population-based cardiovascular risk screening, including medical history, assessment of diet, blood pressure and smoking; and measurement of cholesterol levels (simple lipid panel).
    1. A 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.

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

  1. 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.
    1. Expanded cardiovascular risk panels 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 the standard lipid panel. Other 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 improves outcome.
  2. Tests considered experimental/investigational in determining cardiovascular risk or managing cardiovascular disease include, but are not limited to, the following list:
    1. B-type Natriuretic peptide
    2. Lipoprotein high resolution fractionation and quantitation/ quantification
    3. Quantitation/ quantification of lipoprotein particle numbers and lipoprotein particle subclasses
    4. Retinol binding protein 4 (RBP4)

Codes typically used

Description

0052U

Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of HDL, LDL, and VLDL by vertical auto profile ultracentrifugation

0111T

Long-chain (C20-22) omega-3 fatty acids in red blood cell (RBC) membranes

0423T

Secretory type II phospholipase A2 (sPLA2-IIA)

82163

Angiotensin II

82172

Apolipoprotein, each (includes apolipoprotein A-1 and apolipoprotein B)

82397

Chemiluminescent assay (Leptin)

82541

Column chromatography/mass spectrometry; qual

82542

Column chromatography/mass spectrometry; quant (includes Coenzyme Q10)

82544

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

82610

Cystatin C

82725

Fatty acids, nonesterified. (This test may be requested as nonesterified fatty acids (NEFA) or free fatty acids (FFA)).

82726

Very long chain fatty acids

83520

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified (includes adiponectin, resistin, visfatin, interleukin 6 (IL-6), interleukin 18 (IL-18), oxidized phospholipids, tumor necrosis factor alpha)

83525

Insulin; total

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)

83719

Lipoprotein, direct measurement; VLDL cholesterol

83722

Lipoprotein, direct measurement; small dense LDL cholesterol

83876

Assay myeloperoxidase

83883

Nephelometry, each analyte not elsewhere specified (retinol binding protein 4 [RBP4])

85230

Clotting; factor VII (proconvertin, stable factor) (activated factor VII)

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

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. (2017) 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. Archived September 2017.
  6. Hayes, Inc. Hayes Medical Technology Directory Report. Apolipoprotein B Testing for Screening, Diagnosis, and Management of Dyslipidemia and Cardiovascular Disease. Lansdale, PA: Hayes, Inc.; November, 2000. Reviewed September, 2006. Archived January, 2006.
  7. Hayes, Inc. Hayes Medical Technology Directory Report. Apolipoprotein E Testing for Screening, Diagnosis, and Management of Dyslipidemia and Cardiovascular Disease. Lansdale, PA: Hayes, Inc.; November, 2000. Reviewed October, 2005. Archived January, 2006.
  8. Hayes, Inc. Hayes Medical Technology Directory Report. High-Sensitivity C-Reactive Protein Testing for Diagnosis and Management of Coronary Artery Disease. Lansdale, PA: Hayes, Inc.; March, 2004. Reviewed September, 2008. Archived April, 2009.
  9. Hayes, Inc. Hayes Medical Technology Directory Report. High-Density Lipoprotein Subclass Testing for Screening, Diagnosis, and Management of Dyslipidemia and Cardiovascular Disease. Lansdale, PA: Hayes, Inc.; November, 2000. Reviewed October 2005. Archived January, 2006.
  10. Hayes, Inc. Hayes Medical Technology Directory Report. Homocysteine Testing for Screening, Diagnosis, and Management of Dyslipidemia and Cardiovascular Disease. Lansdale, PA: Hayes, Inc.; September, 2000. Reviewed December, 2005. Archived January, 2006.
  11. 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.
  12. Hayes, Inc. Hayes Medical Technology Directory Report. Low-Density Lipoprotein Subclass Testing for Screening, Diagnosis, and Management of Dyslipidemia and Cardiovascular Disease. Lansdale, PA: Hayes, Inc.; October, 2000. Reviewed December, 2005. Archived January, 2006.
  13. 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.
  14. 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.
  15. Jellinger, P. S., Handelsman, Y., Rosenblit, P. D., Bloomgarden, Z. T., Fonseca, V. A., Garber, A. J., … Davidson, M. (2017). American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocrine Practice, 23(Suppl 2), 1-87.
  16. Moll, S., & Varga, E. A. (2015). Homocysteine and MTHFR mutations. Circulation132(1), e6–e9. 
  17. 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.
  18. Rosenson, R. S. Lipoprotein(a) and cardiovascular disease. In: UpToDate, Freeman, M. W. (Ed), UpToDate, Waltham, MA. (Accessed on December 13, 2018.)
  19. 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.
  20. US Preventive Services Task Force. (2018). Risk assessment for cardiovascular disease and nontraditional risk factors. JAMA, 320(3), 272-280. doi: 10.1001/jama.2018.8359
  21. US Preventive Services Task Force. (2018). Screening for cardiovascular disease risk with electrocardiography. JAMA, 319(22), 2308-2314. doi:10.1001/jama.2018.6848
  22. Wilson, P. W. F. Cardiovascular disease risk assessment for primary prevention: Our approach. In: UpToDate, Gersh, B. J. (Ed), UpToDate, Waltham, MA. (Accessed on December 13, 2018).

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
  • 03/01/2019 - Effective date
Review date
  • 12/2018
Revision date
  • 02/08/2019

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