CPT code 83718: HDL cholesterol, direct measurement2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Directly measures HDL cholesterol in blood for lipid assessment and cardiovascular risk evaluation when an HDL result is ordered.
Medicare pays $8.19 for 83718 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$8.19
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- QW · CLIA-waived test
- $8.19
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 83718 covers
This assay directly measures high-density lipoprotein cholesterol in a blood specimen. Clinicians order it to assess a patient's lipid profile and cardiovascular risk, including during evaluation or monitoring of dyslipidemia. Clinical laboratories perform and report the test for outpatient and other care settings. It may be ordered alone or as part of a lipid assessment and measures HDL cholesterol rather than lipoprotein particle counts or subclasses.
Report one unit for each separately performed HDL cholesterol assay. When the complete lipid panel is performed, report the panel rather than separately reporting its included HDL measurement. Modifier QW identifies the CLIA-waived version for sites holding a CLIA certificate of waiver. Medicare pays this test only under the CLFS, at one national amount across states and localities with no office-versus-facility difference. The 2026 national amount is $8.19, unchanged since 2020.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 83718
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 83718. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 83718 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 83718 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $8.19.
83718 on the lab fee schedule since 2020
83718 · CLFS 2026 Q4 (current)
$8.19
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
83718 compared with similar tests
- 80061Lipid panelCholesterol and triglycerides$13.39
- Use the lipid panel code when the complete panel is performed; this code represents the HDL measurement alone.
- 83721LDL cholesterolDirect LDL measurement$10.50
- 83721 measures LDL cholesterol directly. Use 83718 for the HDL cholesterol result.
- 83701Lipoprotein profileHigh-resolution fractions$33.86
- 83701 is for high-resolution lipoprotein fractionation and quantitation, not a direct HDL cholesterol measurement.
83718 billing questions
When should I report this instead of the lipid panel code?
Report this code when HDL cholesterol is measured without the complete lipid panel. When all components of the lipid panel are performed, report the panel rather than separately reporting its HDL component.
How does this differ from the direct LDL cholesterol assay?
This code reports HDL cholesterol. The direct LDL assay reports low-density lipoprotein cholesterol, a different lipid measurement.
When is modifier QW appropriate?
Use QW for the CLIA-waived version when performed by a site holding a CLIA certificate of waiver.
How many units should be reported?
Report one unit for each separately performed HDL cholesterol assay.
How does Medicare pay this test?
Medicare pays it under the CLFS at one national amount, the same across localities and in office and facility settings.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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