CPT code 83721: LDL cholesterol, direct LDL measurement2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Directly measures LDL cholesterol in a blood specimen for lipid evaluation, including situations where a calculated LDL result is unavailable or unsuitable.
Medicare pays $10.50 for 83721 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
$10.50
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
- $10.50
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 83721 covers
This assay directly measures low-density lipoprotein (LDL) cholesterol in a blood specimen. It is used in lipid evaluation when a direct LDL result is needed, including when a calculated result is unavailable or unsuitable. Clinical laboratories, hospital laboratories, and eligible waived-testing sites may perform the test; clinicians use the result to assess a patient’s lipid profile and cardiovascular risk.
Report 83721 for the direct LDL measurement, rather than for an LDL value calculated from other lipid results. CMS also lists a CLIA-waived version, reported with modifier QW by a site holding a CLIA certificate of waiver. Medicare pays the test through the CLFS, not the physician fee schedule. The 2026 national CLFS amount is $10.50 and has remained unchanged since 2020. The amount is the same across states and localities, with no office-versus-facility difference.
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 83721
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 83721. 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 83721 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 83721 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $10.50.
83721 on the lab fee schedule since 2020
83721 · CLFS 2026 Q4 (current)
$10.50
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.
83721 compared with similar tests
- 80061Lipid panelCholesterol and triglycerides$13.39
- 80061 reports a lipid panel, with an LDL value that may be calculated from the panel’s measured components. 83721 reports a direct LDL cholesterol assay.
- 83718HDL cholesterolDirect measurement$8.19
- 83718 directly measures HDL cholesterol; 83721 directly measures LDL cholesterol.
- 83719VLDL cholesterolDirect measurement$12.75
- 83719 directly measures VLDL cholesterol; 83721 directly measures LDL cholesterol.
- 83722Small dense LDLDirect cholesterol measurement$34.19
- 83722 is specific to small dense LDL cholesterol, while 83721 reports direct LDL cholesterol measurement more broadly.
83721 billing questions
When should 83721 be selected instead of an LDL result from a lipid panel?
Use 83721 for a directly measured LDL cholesterol assay. A lipid panel may include an LDL value calculated from its other lipid results; that calculated value is not the direct assay reported by 83721.
Does 83721 measure HDL or VLDL cholesterol?
No. 83721 measures LDL cholesterol. Direct HDL and VLDL cholesterol assays are distinct tests reported with 83718 and 83719, respectively.
When is modifier QW appropriate?
CMS lists a CLIA-waived version of 83721 with modifier QW. Use QW when the test is performed as a waived test at a site holding a CLIA certificate of waiver.
What should the documentation support?
The documentation should support that a direct LDL cholesterol measurement was performed, rather than an LDL value calculated from other lipid results.
How does Medicare pay for 83721?
Medicare pays 83721 from the CLFS. It has one national amount across localities and settings, and it is excluded from the physician fee schedule.
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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