CLIA Waivers and U.S. Medicare Reimbursement
for Healthcare Professionals
Steps to Obtain Medicare Reimbursement for Lipid and A1C Testing
The first step for a physician office to obtain Medicare reimbursement for point-of-care lipid and A1C testing is to obtain a CLIA Certificate of Waiver. The physician office or laboratory will need to pay a fee every two years, and agree to follow manufacturer’s instructions for performing clinical lab tests.
Download the instructions and the CLIA Certificate of Waiver form from Centers for Medicare & Medicaid Services website:
How to Obtain a CLIA Certificate of Waiver
CLIA Certificate of Waiver Form (CMS116)
Lipid CPT Coding
Frequency Limitations:
Patients on anti-lipid dietary/drug therapy
• One lipid profile per year
• One component of lipid panel or direct LDL up to 6 times during the first year
• Total cholesterol or direct LDL up to 3 times per year after treatment goals are achieved
• Triglycerides if elevated or patient is on drugs which may raise triglyceride levels
A1c CPT Coding
References
