CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Is E78.0 a billable ICD-10-CM code?

No. E78.0 is a non-billable header code. You must report a more specific child code (with additional characters after the decimal) for billing.

What procedures are commonly billed with E78.0?

Procedures frequently paired with E78.0 include 80000 (Laboratory Test 80000), 80050 (Laboratory Test 80050), 80100 (Laboratory Test 80100), 80150 (Laboratory Test 80150), 80200 (Laboratory Test 80200), 80250 (Laboratory Test 80250). The diagnosis must support medical necessity for the service billed.

ICD-10-CM · E00–E89Non-billable header

ICD-10-CM Code E78.0

Pure hypercholesterolemia

Source: CMS ICD-10-CM FY2026Effective October 1, 2025Reviewed by the D3rx Clinical Billing Team

Diagnosis information

Billable

Use a specific child code

Chapter

E00–E89

Endocrine, nutritional and metabolic diseases

Risk adjustment

None

Not risk-adjustable (V28)

This is a parent/header code. For billing you must select a more specific child code (with additional characters after the decimal) that documents the precise diagnosis.

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Procedures commonly billed with E78.0

CPT/HCPCS procedures frequently paired with E78.0 on claims. The diagnosis helps support medical necessity for the service, but documentation, the service performed, and payer/CMS policy all apply — link each line item to the diagnosis that best documents why it was needed.

80000Laboratory Test 80000
80050Laboratory Test 80050
80100Laboratory Test 80100
80150Laboratory Test 80150
80200Laboratory Test 80200
80250Laboratory Test 80250
80300Laboratory Test 80300
80350Laboratory Test 80350

More codes in the E78 category

Other billable ICD-10-CM codes in the same category as E78.0. Coding to the highest specificity the documentation supports is what keeps a claim clean — pick the child code that most precisely matches the diagnosis.

E78.00Pure hypercholesterolemia, unspecified
E78.010Homozygous familial hypercholesterolemia [HoFH]
E78.011Heterozygous familial hypercholesterolemia [HeFH]
E78.019Familial hypercholesterolemia, unspecified
E78.1Pure hyperglyceridemia
E78.2Mixed hyperlipidemia
E78.3Hyperchylomicronemia
E78.41Elevated Lipoprotein(a)
E78.49Other hyperlipidemia
E78.5Hyperlipidemia, unspecified
E78.6Lipoprotein deficiency
E78.70Disorder of bile acid and cholesterol metabolism, unspecified

Documentation & coding notes

E78.0 is a non-billable header code. Report a more specific child code (with additional characters after the decimal) instead; a header code on a claim is a common cause of front-end rejections.
Always verify the code against the current ICD-10-CM Official Guidelines and the payer's coverage policy before submitting — coverage, medical necessity edits, and sequencing rules vary by payer.

Related E00–E89 codes

E11.9 E78.5 E66.9 E11.65 E11.22 E66.01 E03.9 E55.9

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Medical coding disclaimer

ICD-10-CM codes and descriptions shown are from the CMS FY2026 official code set and HCC mappings from the CMS-HCC V28 model (payment year 2026), shown for educational reference. Official Guidelines, payer coverage, medical-necessity edits, and sequencing rules vary. Always verify with the current ICD-10-CM Official Guidelines and the payer before submitting claims. D3rx is not responsible for coding or billing outcomes.