U.S. Reimbursement - Professional

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

Lipid CPT or current procedural terminology 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