Dyslipidemia Screening and Billing with Highmark Wholecare

As part of the Early Periodic Screening, Diagnostic, and Testing (EPSDT) Schedule, Dyslipidemia is a Universal Screening that occurs during two age ranges and at other times if indicated by history and symptoms.

Screenings for Dyslipidemia should occur at the following ages:

• Once between ages 9 to 11
• Once between ages 17 to 20

Other ages should be screened based on history and symptoms.

Billing

All EPSDT screening services must be reported with the age-appropriate evaluation and management code along with the EP modifier.

• 9 year to 11 year EPSDT visit CPT code is 99383 or 99393
• 17 year to 20 year EPSDT visit CPT code is 99384 or 99394

The CPT code suggested for Dyslipidemia Screening is 80061.                                                                                                             

Modifier:

• Modifier 90 should be applied when laboratory procedures are performed by a party other than the treating or reporting physician-use the CPT code plus modifier 90 to reference Outside Lab. This modifier is used to indicate that, although the physician is reporting the performance of a laboratory test, the actual testing component was a service from laboratory.
• Modifier 52 should be applied for a Dyslipidemia Screening that may not be completed. If a screening service or component is reported with modifier 52, the provider must complete the screening service or component during the next screening opportunity according to the Periodicity Schedule.

References:

• AAP Clinical Report on Lipid Screening in Children | AAFP

For questions regarding the EPSDT program, please contact EPSDTinfo@HighmarkWholecare.com.

These codes are not all encompassing and use do not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.