2025 CPT code 3050F
(Active) Effective Date: N/A Revision Date: N/A Performance Measurement - Diagnostic/Screening Processes or Results Category II Codes Feed
Most recent LDL-C level ≥ 130 mg/dL, indicating increased risk of coronary artery disease (CAD) or diabetes mellitus (DM).
Modifiers are not applicable to Category II codes.
Medical necessity for this code is established when the physician orders and interprets LDL-C testing to evaluate the patient's risk for CAD and DM based on the clinical picture and risk factors.Documentation demonstrating the medical necessity of the test is required for appropriate coding.
The clinical responsibility involves ordering and interpreting the LDL-C test, assessing the patient's risk for CAD and DM based on the result, and adjusting treatment plans (e.g., medication, lifestyle changes) accordingly.
In simple words: This code tracks a blood test result showing a high level of "bad" cholesterol (LDL). High LDL cholesterol increases your risk for heart disease and diabetes.Doctors use this information to make treatment plans.
This Category II CPT code reports the most recent low-density lipoprotein cholesterol (LDL-C) level of 130 mg/dL or higher.LDL-C is a lipid profile measurement indicating the amount of cholesterol bound to LDL in the blood.Elevated LDL-C levels are associated with an increased risk of developing coronary artery disease (CAD) and diabetes mellitus (DM). The code does not have a relative value and is used for performance measurement and quality improvement, not for reimbursement.
Example 1: A 55-year-old male with a family history of heart disease presents for a routine checkup. His LDL-C level is 140 mg/dL. The physician uses code 3050F to document this result and initiates a discussion about lifestyle modifications and statin therapy., A 40-year-old female with newly diagnosed type 2 diabetes has an LDL-C level of 135 mg/dL.The code 3050F documents this finding, and the physician adjusts the patient's diabetes management plan to include aggressive cholesterol management., A 60-year-old male recovering from a myocardial infarction has an LDL-C level of 160mg/dL. This is documented using code 3050F, and the physician modifies his medication regimen to lower his LDL-C to minimize future cardiovascular events.
The patient's medical record should contain the following:
** This code is optional and should be used in conjunction with appropriate Category I codes for the services provided.
- Payment Status: Inactive
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Endocrinology, Internal Medicine, Family Medicine
- Place of Service:Office, Hospital Outpatient, Clinical Laboratory