About this policy
Jurisdiction: JJ Part B. States: Alabama, Georgia, Tennessee. Type: Active LCD
Coverage indications
B-type natriuretic peptide (BNP) and its precursor amino terminal (NT-proBNP) increase in patients with cardiac disease due to myocardial stress and volume overload as found in heart failure (HF). 3 When used in conjunction with other clinical information, the rapid measurement of levels of BNP or NT-proBNP is useful in establishing or excluding the diagnosis of HF as well as assessing the severity of HF in patients with acute dyspnea so that appropriate and timely treatment can be initiated. 8 This test may also be used to predict the long-term risk of cardiac events or death across the spectrum of acute coronary syndromes when measured in the first few days after an acute coronary event. 9 There is no conclusive evidence currently to warrant the repeated or serial use of BNP or NT-proBNP to alter or monitor treatment of HF especially in hospital inpatients. 16 Therefore, repeated or serial use of BNP or NT-proBNP measurements for monitoring and management of CHF are not a covered service. 17 The measurement of BNP as part of cardiovascular risk assessment panels, consisting of various combinations of biochemical, immunologic, hematologic, and molecular tests, is considered screening when performed on an asymptomatic patient, and, as such, is not a covered Medicare benefit. Please refer to MolDX: Biomarkers in Cardiovascular Risk Assessment L36129 Local Coverage Determination (LCD).
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 83880 | CPT | Covered |
| E85.81 | ICD10CM | Covered |
| E85.82 | ICD10CM | Covered |
| E85.89 | ICD10CM | Covered |
| I11.0 | ICD10CM | Covered |
| I13.0 | ICD10CM | Covered |
| I13.2 | ICD10CM | Covered |
| I16.0 | ICD10CM | Covered |
| I16.1 | ICD10CM | Covered |
| I16.9 | ICD10CM | Covered |
| I1A.0 | ICD10CM | Covered |
| I20.0 | ICD10CM | Covered |