Summary
Lipid panel (CPT 80061) is covered once per calendar year as part of the Healthy You! wellness benefit. Diagnostic lipid testing may be considered medically necessary when it meets the listed criteria, and monitoring of dietary or pharmacologic therapy is covered up to three times per calendar year. A 10/01/2026 code update added ICD-10 diagnosis codes K74.0A and K76.83 to the Code Reference section and removed deleted ICD-10 diagnosis code E88.1.
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What to do
Action · 6 steps
01Already effective 10/01/2026: The Code Reference section adds ICD-10 diagnosis codes K74.0A and K76.83 and removes deleted ICD-10 diagnosis code E88.1.
02Lipid panel (CPT 80061) is covered once per calendar year as part of the Healthy You!
03wellness benefit.
04Diagnostic lipid testing needs one of the listed criteria, such as follow-up to an initial screen when total cholesterol is above 240 mg/dL, borderline-high total cholesterol (200-240 mg/dL) with two or more coronary heart disease risk factors, or HDL cholesterol below 35 mg/dL.
05Monitoring is covered up to three times per calendar year for dietary or pharmacologic therapy, and is considered not medically necessary if no dietary or pharmacological therapy is advised.
06The listed codes are medically necessary only when the procedure is performed according to the Policy section.
Codes mentioned
80061K74.0AK76.83
Original notice
Lipid Testing
bcbsms.com · Always check the source before changing claims.
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