Summary & Overview
CPT 83698: Lipoprotein-associated Phospholipase A2 (Lp-PLA2) Assay
CPT code 83698 designates a laboratory assay that measures lipoprotein-associated phospholipase A2 (Lp-PLA2) in a patient specimen. Lp-PLA2 is a circulating enzyme associated with vascular inflammation and is used as a biomarker to help assess cardiovascular risk. Nationally, this code matters because it represents a discrete lab-based risk stratification test that can affect patient management decisions and utilization of downstream cardiovascular services.
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 Lp-PLA2 testing, typical settings where the service is provided (clinical and hospital laboratories), and the types of benchmarks and policy issues commonly reviewed for lab codes—coverage patterns, reimbursement policies, and coding guidance. The publication also summarizes where to expect variability in payer coverage and highlights common administrative considerations related to laboratory processing and reporting.
This summary is intended to orient clinicians, billing staff, and policy analysts to the clinical purpose of CPT code 83698, the payer landscape, and the kinds of policy and operational details covered in the full publication.
Billing Code Overview
CPT code 83698 measures the amount of lipoprotein-associated phospholipase A2, commonly called Lp-PLA2, in a patient specimen. This laboratory test quantifies an enzyme linked to vascular inflammation and cardiovascular risk, providing clinicians with a biomarker to inform clinical assessment.
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Service type: Clinical laboratory assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a middle-aged or older adult referred by a primary care provider or cardiology clinic for laboratory assessment of cardiovascular risk. The patient often has risk factors such as hyperlipidemia, hypertension, diabetes mellitus, or a family history of premature coronary artery disease. A blood specimen (serum or plasma) is collected in an outpatient phlebotomy setting, hospital laboratory, or ambulatory clinic; the specimen is routed to the clinical chemistry laboratory where the laboratory analyst performs an assay to measure lipoprotein-associated phospholipase A2 (Lp-PLA2) activity or mass using a validated immunoassay or enzymatic method. Results are reported to the ordering provider and incorporated into cardiovascular risk stratification and management considerations. Typical sites of service include the hospital outpatient laboratory, independent clinical laboratory, ambulatory clinic laboratory, or inpatient hospital laboratory when cardiovascular risk assessment is performed during hospitalization.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Attach when billing only the professional interpretation component if applicable (rare for automated lab assays). |