Summary & Overview
CPT 3048F: LDL-C Test Result <100 mg/dL
CPT code 3048F documents a patient’s most recent low-density lipoprotein cholesterol (LDL-C) test result of less than 100 mg/dL. This result-based performance measure is commonly used in chronic disease management and preventive care to track lipid control and cardiovascular risk. Nationally, consistent capture of LDL-C levels supports quality measurement, population health management, and medication adjustment decisions by clinicians.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical meaning of the code, typical sites of service, and what benchmarks and policy context are relevant when this code is used in reporting and quality measurement. The publication summarizes common billing practice elements, where available, and outlines the clinical rationale linking LDL-C results to coronary artery disease and diabetes management.
The piece provides guidance on expected use cases and the role of the code in performance tracking and care management, along with a summary of payer coverage considerations and how the code fits within broader lipid monitoring workflows. Data not available in the input.
Billing Code Overview
CPT code 3048F indicates the most recent low-density lipoprotein cholesterol (LDL-C) test result of less than 100 mg/dL. The code is used to document the patient’s LDL-C level within a clinical or preventive care encounter.
Service type: Laboratory test — lipid panel focused on LDL-C level
Typical site of service: Outpatient clinics, ambulatory care settings, primary care offices, cardiology clinics, and outpatient laboratory facilities
This code is used to record a specific laboratory result value for clinical tracking of cholesterol management and cardiovascular risk assessment. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of hyperlipidemia and Type 2 diabetes presents for a routine chronic disease follow-up. The clinician orders a lipid panel that includes an LDL-C measurement to assess cardiovascular risk and medication efficacy. A venous blood sample is collected in the outpatient clinic laboratory or at a commercial laboratory; results are returned to the provider and documented in the medical record. The most recent LDL-C level is reported as less than 100 mg/dL and is captured as 3048F on the encounter claim or quality report. Typical workflow steps include patient check-in, phlebotomy, lab processing, result review by the ordering clinician, and medication or lifestyle counseling documented in the visit note. Typical sites of service are outpatient clinic, physician office, ambulatory care center, and hospital outpatient laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard claim submission | Use on claims when no special modifier applies and service performed as usual. |
| 95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the related visit or result review is conducted via live telemedicine and payer requires modifier for the professional service portion. |