Lipoprotein-associated Phospholipase A2 Testing denials: what the review data shows
Independent reviewers have decided 12 published cases where an insurer denied Lipoprotein-associated Phospholipase A2 Testing — and they overturned the insurer 0% of the time. A denial for Lipoprotein-associated Phospholipase A2 Testing is a starting position, not a final answer.
Conditions behind lipoprotein-associated phospholipase a2 testing denials
| Category | Decisions | Overturned |
|---|---|---|
| Dyslipidemia | 4 | 0% |
Where the denial was upheld
Nature of Statutory Criteria/Case Summary: An enrollee has requested reimbursement for laboratory testing components (lipoprotein-associated phospholipase A2) and/or (apolipoprotein B).Findings: The physician reviewer found that here is lack of clinical studies demonstrating that advanced lipoprotein testing adds significant actionable information to information yielded with a basic fasting lipid panel. Harada and colleagues noted that the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines do not issue any recommendation for advanced lipoprotein testing.
Nature of Statutory Criteria/Case Summary: An enrollee has requested reimbursement for advanced lipoprotein testing CPT code 83698 and CPT codes 82172, 83695, 83701, and 83701-59 performed on a separate date of service. Findings: The physician reviewers found that in this circumstance, prevention guidelines for the management of cardiac risk and dyslipidemia have been established. These guidelines are periodically updated by expert committees and are endorsed by several national organizations.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Lipoprotein-associated Phospholipase A2 Testingwhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY