CPT code 84478: Triglycerides, individual measurement2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Measures triglycerides in blood to assess lipid status, investigate elevated levels, or monitor patients receiving care for dyslipidemia or related conditions.
Medicare pays $5.74 for 84478 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
$5.74
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
- $5.74
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 84478 covers
This blood test measures triglycerides, a type of circulating lipid. It is commonly ordered to assess lipid status, evaluate elevated triglyceride levels, or monitor response to treatment. Clinical laboratories generally test serum or plasma; some sites may perform a waived version at the point of care. Primary care, cardiology, and endocrinology practices commonly order the assay.
Report 84478 for the triglyceride measurement when it is performed as an individual test. When a lipid panel is performed, triglycerides are included in the panel rather than reported again as a separate component. CMS lists a CLIA-waived version with modifier QW for eligible sites holding a certificate of waiver. Medicare pays the test only through the CLFS. The 2026 national amount is $5.74, unchanged since 2020; one amount applies nationwide, without locality or office-versus-facility differences.
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 84478
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 84478. 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 84478 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 84478 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $5.74.
84478 on the lab fee schedule since 2020
84478 · CLFS 2026 Q4 (current)
$5.74
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.
84478 compared with similar tests
- 80061Lipid panelCholesterol and triglycerides$13.39
- Use 80061 when the ordered service is a lipid panel that includes triglycerides and other lipid measurements. Use 84478 for an individual triglyceride assay.
- 82465CholesterolTotal, serum or whole blood$4.35
- 82465 measures total cholesterol; 84478 measures triglycerides. They are distinct analytes and may be ordered separately.
- 83718HDL cholesterolDirect measurement$8.19
- 83718 measures HDL cholesterol, while 84478 measures triglycerides. Choose the code for the analyte actually tested.
84478 billing questions
When should 84478 be reported instead of a lipid panel?
Use 84478 when the triglyceride assay is performed as an individual test. A lipid panel includes triglycerides along with other lipid measurements, so report the panel when that set of tests is performed.
Can 84478 be billed separately with a lipid panel?
Do not report 84478 separately for the triglyceride measurement already included in a lipid panel. Report it separately only when an individual triglyceride assay is performed apart from the panel.
When is modifier QW relevant?
CMS lists a CLIA-waived version of this test with modifier QW. Use QW for the waived test performed at a site holding a CLIA certificate of waiver.
How many units should be reported?
Report the individual triglyceride assay performed; the code is not a count of the different analytes in a lipid panel.
How does Medicare pay for 84478?
Medicare pays this test through the CLFS at one national amount, with no locality or office-versus-facility difference. It is paid only from the CLFS.
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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