Summary & Overview
CPT 82465: Total Cholesterol Measurement in Serum or Whole Blood
CPT code 82465 identifies a laboratory assay that measures total cholesterol in serum or whole blood. Total cholesterol is a core biomarker used in cardiovascular risk assessment and population health screening, making this test widely used across clinical settings. Nationally, services billed under CPT code 82465 support preventive care, chronic disease management, and medication monitoring for lipid-lowering therapies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the test, typical sites of service, and payer coverage landscape. The publication summarizes billing considerations, common modifiers encountered in claims, and where CPT code 82465 fits within laboratory service lines.
This report provides benchmarks and policy-relevant points for stakeholders evaluating utilization and coverage of total cholesterol testing. It also outlines clinical scenarios in which measurement of total cholesterol is commonly ordered and highlights where to find related procedural coding. Data not available in the input will be indicated when applicable.
Billing Code Overview
CPT code 82465 measures total cholesterol in a patient specimen of serum or whole blood. This is a laboratory quantitative assay that reports the concentration of total cholesterol as part of a lipid profile or standalone cardiovascular risk assessment.
Service Type: Clinical laboratory test — quantitative serum or whole blood analysis
Typical Site of Service: Clinical laboratory, hospital laboratory, outpatient laboratory draw site, or physician office laboratory
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Clinical & Coding Specifications
Clinical Context
A 54-year-old male patient presents to an outpatient primary care clinic for routine cardiovascular risk assessment. The clinician documents a history of hyperlipidemia and hypertension and orders fasting laboratory studies including a lipid panel. Nursing obtains a serum specimen via venipuncture and sends it to the facility laboratory. The medical laboratory analyst performs a quantitative enzymatic assay to measure the level of total cholesterol in the specimen and records the result in the laboratory information system. The result is reviewed by the ordering provider and incorporated into clinical decision-making for lipid-lowering therapy and risk stratification. Typical site of service is an outpatient laboratory or hospital laboratory performing routine clinical chemistry testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if applicable to lab services that have separate technical/professional components (rare for automated chemistry). |
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside/reference laboratory for completion of the test. |