NMR lipid profile coverage

[ATHiker95]

I read that Medicare will cover a basic lipid panel every 5 years. I’m new to Medicare and have diabetes and rheumatoid arthritis, both of which can affect the heart. I’m curious if anyone knows if Medicare will cover and advanced panel such as the NMR which will give you particle count, particle size, etc?

Thanks,
Mark

 

[MBSC]

I found the following articles which indicate Medicare does cover the NMR lipid panel when medically necessary. I would suggest you contact your doctor to determine if Medicare will cover the test for your particular situation.

18. The NMR LipoProfile test costs around $100. Medicare covers the cost of the test and most private insurance providers cover a portion, as well.

Reference: https://www.lipidcenter.com/er_faq.php#18

The Centers for Medicare & Medicaid Services (CMS) announced a Medicare reimbursement rate for CPT code 83704, a new code that describes the main component of the NMR LipoProfile(R) test...The establishment of a new code and a CMS payment rate are key steps in making new medical technologies more widely available to patients.

Reference: https://www.billing-coding.com/detail_article.cfm?articleID=273