Summary & Overview
CPT 83695: Quantitative Lipoprotein(a) Measurement
CPT code 83695 represents a quantitative laboratory measurement of lipoprotein(a) concentration in patient blood. Lipoprotein(a) testing is clinically relevant because elevated levels are associated with increased cardiovascular risk and can influence risk stratification and management decisions. Nationally, use of targeted biomarker assays such as lipoprotein(a) has grown as clinicians incorporate more personalized cardiovascular risk assessment into care plans.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical purpose, typical sites of service, and common billing considerations. The publication includes benchmarking context, payer coverage patterns, and a summary of relevant policy updates that affect laboratory billing and reimbursement for quantitative lipoprotein(a) testing.
The content is intended to help revenue cycle leaders, laboratory directors, clinicians, and policy analysts understand coding implications, payer coverage landscape, and operational considerations tied to CPT code 83695. Data not available in the input is identified explicitly where applicable.
Billing Code Overview
CPT code 83695 describes a laboratory assay performed by a lab analyst to measure the concentration of lipoprotein(a) in a patient blood sample. This test quantifies levels of a lipoprotein particle associated with cardiovascular risk assessment and management.
Service Type: Laboratory — Quantitative Lipoprotein(a) Measurement
Typical Site of Service: Clinical laboratory or hospital laboratory. The procedure is performed on a blood specimen collected in an outpatient clinic, physician office, or inpatient setting and processed in a clinical laboratory.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with a strong family history of premature coronary artery disease and persistently elevated LDL cholesterol presents to a primary care clinic for cardiovascular risk assessment. The clinician orders a lipoprotein(a) assay to quantify Lp(a) concentration as part of a comprehensive lipid and risk stratification panel. Blood is collected via routine venipuncture in the outpatient laboratory or phlebotomy station. The specimen is processed and sent to the clinical chemistry laboratory where a medical laboratory scientist or technologist performs the 83695 assay using an immunoassay or mass-based method to report lipoprotein(a) mass or concentration. Results are routed back to the ordering provider through the electronic medical record. Typical sites of service include outpatient hospital laboratories, independent clinical laboratories, and physician office laboratories. Indications include unexplained premature atherosclerotic cardiovascular disease, strong family history of cardiovascular events, refractory hyperlipidemia despite therapy, or evaluation prior to advanced lipid-lowering therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing physician interpretation or oversight of the test result separate from the technical component |