Anthem Blue Cross Connecticut LAB.00031 Advanced Lipoprotein Testing Form

This document addresses the use of advanced testing of lipoproteins for cardiovascular disease (CVD) risk assessment and management, and all other indications. Lipoproteins are blood-borne complexes of lipids and proteins that allow the transport of cholesterol throughout the body. This document does not address the use of a basic lipid panel or lipoprotein genotyping.

Position Statement

Investigational and Not Medically Necessary:

Advanced lipoprotein testing (testing beyond that of a basic lipid panel) is considered investigational and not medically necessary for all indications, including for cardiovascular disease (CVD) risk assessment and management. Advanced lipoprotein testing includes, but is not limited to:

1. Apolipoprotein A-I (apoAI);
2. Apolipoprotein B (apoB);
3. Apolipoprotein E (apoE);
4. Intermediate density lipoproteins (IDL);
5. Lipoprotein(a) (Lp(a)) enzyme immunoassay;
6. Lipoprotein-associated phospholipase A2 (Lp-PLA2);
7. Small density lipoproteins.