Summary & Overview
CPT 84478: Triglycerides Measurement, Lipid Assessment
CPT code 84478 represents a laboratory assay that measures triglyceride levels in a patient specimen, a routine component of lipid panels used to evaluate cardiovascular risk. Nationally, triglyceride testing is a common diagnostic and monitoring tool for patients with atherosclerosis, hyperlipidemia, metabolic syndrome, and other conditions linked to heart disease. The availability and utilization of this test affect clinical decision-making for primary care, cardiology, and endocrinology practices and are relevant to laboratory reimbursement and quality reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the test, the typical service setting, and an overview of payer coverage patterns. The publication also summarizes typical benchmarks and billing considerations relevant to laboratories and providers billing for 84478, highlights common modifiers used alongside laboratory CPT codes, and notes where input data is not available. This material is intended to inform administrators, billing professionals, and clinicians about the clinical role of the test and the payer landscape at a national level.
Billing Code Overview
CPT code 84478 measures the amount of triglycerides in a patient specimen. The test is ordered to assess lipid levels and cardiovascular risk, commonly for patients with atherosclerosis, other arterial diseases, or those at risk for developing heart disease.
Service type: Laboratory diagnostic test (clinical chemistry)
Typical site of service: Clinical laboratory or hospital outpatient laboratory, with specimens collected in ambulatory clinics or inpatient settings as appropriate.
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with known hyperlipidemia and a history of peripheral arterial disease presents for routine cardiovascular risk assessment. The ordering clinician requests a fasting lipid panel that includes a triglyceride measurement to evaluate residual atherogenic risk and to guide lipid-lowering therapy adjustments. In the clinical workflow, a phlebotomist obtains a fasting blood specimen in an outpatient clinic or ambulatory laboratory. The specimen is routed to the clinical chemistry lab where a medical technologist or lab analyst performs the quantitative triglyceride assay using enzymatic colorimetric methods. Results are reported in milligrams per deciliter (mg/dL) and entered into the electronic medical record for the provider to review during a follow-up visit or via patient portal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing for the physician interpretation component separate from the lab technical service (rare for automated chemistry tests). |
59 | Distinct procedural service | Use when triglyceride testing is performed separately from other billed services and meets distinct procedural criteria. |