Local Coverage Determination (LCD)

Brain Natriuretic Peptide (BNP) Level

L33422

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Palmetto GBA	A and B MAC	10112 - MAC B	J - J	Alabama
Palmetto GBA	A and B MAC	10212 - MAC B	J - J	Georgia
Palmetto GBA	A and B MAC	10312 - MAC B	J - J	Tennessee
Palmetto GBA	A and B and HHH MAC	11202 - MAC B	J - M	South Carolina
Palmetto GBA	A and B and HHH MAC	11302 - MAC B	J - M	Virginia
Palmetto GBA	A and B and HHH MAC	11402 - MAC B	J - M	West Virginia
Palmetto GBA	A and B and HHH MAC	11502 - MAC B	J - M	North Carolina

LCD Information

Document Information

LCD ID
L33422

LCD Title
Brain Natriuretic Peptide (BNP) Level

Proposed LCD in Comment Period
N/A

Source Proposed LCD
N/A

Original Effective Date
For services performed on or after 10/01/2015

Revision Effective Date
For services performed on or after 06/10/2021

Revision Ending Date
N/A

Retirement Date
N/A

Notice Period Start Date
N/A

Notice Period End Date
N/A

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(1)(D) addresses items related to research and experimentation.

Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups.

42 CFR §410.32(a) indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements).

CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.1 Diagnostic Services Defined

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It is secreted in response to ventricular volume expansion and pressure overload, factors often found in congestive heart failure (CHF). Used in conjunction with other clinical information, rapid measurement of BNP is useful in establishing or excluding the diagnosis and assessing the severity of CHF in patients with acute dyspnea, so that appropriate and timely treatment can be initiated. This test is also 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.

Indications:

1. BNP measurements are used to distinguish cardiac cause of acute dyspnea from pulmonary or other non-cardiac causes.

2. BNP is particularly useful in distinguishing decompensated CHF from exacerbated chronic obstructive pulmonary disease (COPD) in a symptomatic patient with combined CHF and COPD.

3. BNP is a risk stratification tool used to assess risk of death, myocardial infarction or CHF among patients with acute coronary syndrome (myocardial infarction with or without T-wave elevation and unstable angina).

4. Routine assays of BNP can be used to assess the effectiveness of CHF therapy and for titration of heart failure therapy.

Limitations:

1. Measurement of BNP as part of cardiovascular risk assessment panels, consisting of various combinations of biochemical, immunologic, hematologic and molecular tests is considered a screening when performed on an asymptomatic patient and is not a Medicare benefit. Refer to the MolDX: Biomarkers in Cardiovascular Risk Assessment L36129 Local Coverage Determination (LCD).

2. Routine assays of only BNP to screen for the development of left ventricular dysfunction or new onset Heart Failure in asymptomatic patients is not covered due to statutory limitations.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes

Changes	Fields Changed
	N/A

Associated Information

Sources of Information

Bibliography

Open Meetings

Contractor Advisory Committee (CAC) Meetings

MAC Meeting Information URLs

Proposed LCD Posting Date

Comment Period Start Date

Comment Period End Date

Reason for Proposed LCD

Contact for Comments on Proposed LCD

Coding Information

ICD-10-CM Codes that Support Medical Necessity

ICD-10-CM Codes that DO NOT Support Medical Necessity

Additional ICD-10 Information

General Information

Associated Information

Documentation Requirements

The patient's medical record must document the medical necessity of services performed for each date of service submitted on a claim. Documentation must support medical necessity, be legible, maintained in the patient’s medical record and made available to the A/B MAC upon request.

Utilization Guidelines

Services performed which are considered excessive frequency are not medically necessary. Frequency is considered excessive when services are performed more frequently than generally accepted by peers and the reason for additional services is not justified by documentation.

Sources of Information
N/A

Bibliography

Baughman KL. B-type natriuretic peptide - A window to the heart. N Engl J Med. 2002;347(3):158-9.

Latini R, Masson S, Wong M, et al. Incremental prognostic value of changes in B-type natriuretic peptide in heart failure. Am J Med. 2006;119(1):70.e23-30.

Lubien E, DeMaria A, Krishnaswamy P, et. al. Utility of B-natriuretic peptide in detecting diastolic dysfunction: Comparison with doppler velocity recordings. Circ. 2002;105(5):595-601.

Maisel AS, Clopton P, Krishnaswamy P, et al. Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: Results from the breathing not properly (BNP) multinational study. Am Heart Jour. 2004;147(6):1078-1084.

Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-7.

Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: Comparison with tissue doppler imaging recordings. Am Heart Jour. 2004;148(5):895-902.

McCullough PA, Nowak RM, McCord J, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure. Analysis from breathing not properly (BNP) multinational study. Circ. 2002;106(4):416-422.

Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. Jour Am Coll Cardiol. 2002;39(2):202-209.

Shapiro BP, Chen HH, Burnett JC, Redfield MM. Use of plasma brain natriuretic peptide concentration to aid in the diagnosis of heart failure. Mayo Clin Proc. 2003;78(4):481-6.

Wieczorek SJ, Wu AH, Christenson R, et al. A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation. Am Heart J. 2002;144(5):834-9.

Yancy CW, Jessup M, et al. 2017 ACC/AHA/HFSA Focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology. 2017;70(6):776-803.

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation	Reasons for Change
06/10/2021	R15	Under *CMS National Coverage Policy* updated descriptions. Under *Bibliography* changes were made to citations to reflect AMA citation guidelines. Formatting, punctuation and typographical errors were corrected throughout the LCD. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
10/10/2019	R14	This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Regulations regarding billing and coding were removed from the *CMS National Coverage Policy* section of this LCD and placed in the related Billing and Coding: Brain Natriuretic Peptide (BNP) Level A56565 article and removed from the LCD. Formatting, punctuation and typographical errors were corrected throughout the LCD. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance
05/30/2019	R13	All coding located in the *Coding Information* section has been moved into the related Billing and Coding: Brain Natriuretic Peptide (BNP) Level A56565 article and removed from the LCD. Under *Associated Information* Utilization Guidelines the verbiage, “CPT code 83880 may be reasonable once a month for an individual patient. There must be supportive documentation in the medical record to demonstrate the medical necessity of more frequent testing” has been removed. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Public Education/Guidance
01/10/2019	R12	Under *Bibliography* changes were made to reflect AMA citation guidelines. Punctuation was corrected and acronyms were defined where appropriate throughout the policy. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Public Education/Guidance
10/01/2018	R11	Under *Coverage Indications, Limitations and/or Medical Necessity – Indications:* added the verbiage “4. Routine assays of BNP can be used to assess the effectiveness of CHF therapy and for titration of heart failure therapy.” and moved the last paragraph from this section to the *Limitations:* section. Under Coverage Indications, Limitations and/or Medical Necessity – Limitations: deleted the verbiage “Routine assays of BNP to assess the effectiveness of CHF therapy, for titration of heart failure therapy, or for the prognostic usage remains investigational. More data is needed before the clinical utility of BNP in these situations is proven.” and added the verbiage “2. Routine assays of only BNP to screen for the development of left ventricular dysfunction or new onset Heart Failure in asymptomatic patients is not covered due to statutory limitations.” Under *Bibliography* added the reference Yancy CW, Jessup M, et al. 2017 ACC/AHA/HFSA Focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology. 2017;70(6). This revision is due to a reconsideration request. Under *ICD-10 Codes that Support Medical Necessity Group 1: Codes* the code description was revised for ICD-10 codes I63.333 and I63.343. This revision is due to the 2018 Annual ICD-10 Update and is effective on October 1, 2018. At this time 21^stCentury Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Revisions Due To ICD-10-CM Code Changes Reconsideration Request
03/15/2018	R10	Under *Sources of Information and Basis for Decision* deleted “medically” in the first cited source. Deleted “who” from 42 CFR §410.32(a). Deleted the “s” from the cited Internet-Only Manual references X2. Under *Associated Information-Documentation Requirements* added “the” to the second sentence. Under *Bibliography* the full titles were added to several cited journal sources. A spelling error was corrected for Natriuretic, et al was deleted and three author names were added for the following: Morrison LK, Harrison A, Krishnaswamy P, et. al. Utility of a rapid B-Natriuretic Peptide Assay in differentiating Congestive Heart Failure from lung disease in patients presenting with dyspnea. Jour Am Coll Cardiol. 2002;39(2):202-209. The journal title was italicized for the following: Shapiro BP, Chen HH, Burnett JC, Redfield MM. Use of Plasma Brain Natriuretic Peptide Concentration to Aid in the Diagnosis of Heart Failure. Mayo Clin Proc. 2003;78(4):481-6. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Typographical Error Other
02/26/2018	R9	The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.	Change in Affiliated Contract Numbers
10/01/2017	R8	Under *ICD-10 Codes that Support Medical Necessity* added ICD-10 codes I21.9, I21.A1, I21.A9, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89 and R06.03. The code description was revised for ICD-10 codes I50.1, I63.323, I63.333, I63.513, I63.523 and I63.533. These revisions are due to the 2017 Annual ICD-10 Updates. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes
01/05/2017	R7	Under *CMS National Coverage Policy* revised the verbiage in Title XVIII of the Social Security Act, §1862(a)(1)(A) to read “allows coverage and payment for only those services that are considered reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member”, revised the verbiage in Title XVIII of the Social Security Act, §1862(a)(1)(D) to read “ Research and Experimentation” and revised the verbiage in Title XVIII of the Social Security Act, §1862(a)(7) to read “states Medicare will not cover any services or procedures associated with routine physical checkups”. Under *Sources of Information and Basis for Decision* added an author’s name, corrected authors’ initials and added supplement numbers to various references.	Provider Education/Guidance Other (Annual Validation)
11/03/2016	R6	Under *ICD-10 Codes That Support Medical Necessity Group 1: Codes* added R60.0 and R60.1.	Provider Education/Guidance Reconsideration Request
10/01/2016	R5	Under *Coverage Indications, Limitations, and/or Medical Necessity-Abstract* corrected the formatting for the first paragraph. Under *ICD-10 Codes That Support Medical Necessity: Group 1* added I16.0, I16.1, I16.9, I60.2, I63.013, I63.033, I63.113, I63.133, I63.213, I63.233, I63.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433, I63.443, I63.513, I63.523, I63.533, and I63.543. This revision is due to the Annual ICD-10 Code Update.	Provider Education/Guidance Revisions Due To ICD-10-CM Code Changes
01/21/2016	R4	Under CMS National Coverage Policy removed Sec. 1862. [42 U.S.C. 1395y] (a) Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services as it was a duplicate citation. Under Coverage Indications, Limitations and/or Medical Necessity added Abstract- B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It is secreted in response to ventricular volume expansion and pressure overload, factors often found in congestive heart failure (CHF). Used in conjunction with other clinical information, rapid measurement of BNP is useful in establishing or excluding the diagnosis and assessing the severity of CHF in patients with acute dyspnea so that appropriate and timely treatment can be initiated. This test is also 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. Also made grammatical and punctuation corrections. Under Associated Information made grammatical and punctuation corrections. Under Sources of Information and Basis for Decision added reference to McCullough PA, Nowak RM, McCord J, et. al. B-type natriuretic Peptide and clinical judgment in emergency diagnosis of heart failure. Circ.2002;106:416-422. Maisel A, Clopton P, Krishnaswamy P, et al. Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure. Am Heart Jour. 2004;147(6):1078-1084. Latini R, Masson S, Wong M, et al. Incremental Prognostic Value of Changes in B-Type Natriuretic Peptide in Heart Failure. Am J Med. 2006;119(1):70.e23-30. Morrison LK, Harrison A, Krishnaswamy P, et. al. Utility of a rapid B-Natriureti Peptide Assay in differentiating Congestive Heart Failure from lung disease in patients presenting with dyspnea. Jour Am Coll Cardiol.2002;39(2):202-209. Mak GS, DeMaria A, Clopton P, et. al. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function. Am Heart Jour. 2004;148(5):895-902 and Lubien E, DeMaria A, Krishnaswamy P, et. al. Utility of B-natriuretic peptide in detecting diastolic dysfunction. Circ. 2002;105:595-601.	Provider Education/Guidance Public Education/Guidance Typographical Error Other (Annual Validation)
01/21/2016	R3	Under *CMS National Coverage Policy* added the reference to 42 CRF §410.32(a) indicating that diagnostic tests may only be ordered by the treating physician and uses the results in the management of the beneficiary's specific medical problem. Under *Coverage Indications, Limitations and/or Medical Necessity* added last paragraph under Indications indicating BNP included as a component of a CV risk assessment panel is considered screening when performed on an asymptomatic patient. Added the following ICD-10 codes to section titled *ICD-10 Codes that Support Medical Necessity*: I11.0, I13.0, I13.2, I20.0, I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I22.0, I22.1, I22.2, I22.8, I22.9, I25.110, I25.700, I25.710, I25.720, I25.730, I25.750, I25.760, I25.790, I31.1, I42.0, I42.1, I42.2, I42.5, I42.8, I42.9, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9, R06.01, R06.2, and R06.82. These ICD-10 codes were added to consolidate the LCD within a MAC jurisdiction.	Provider Education/Guidance Creation of Uniform LCDs Within a MAC Jurisdiction Revisions Due To ICD-10-CM Code Changes
10/01/2015	R2	Under ICD-10 Codes That Support Medical Necessity added ICD-10 codes inadvertently omitted from the LCD: R06.3 R06.83	Other (ICD-10 Conversion)
10/01/2015	R1	Under *CMS National Coverage Policy* corrected citation by adding CMS Internet-Only Manuals and removing CMS Manual System, Under *Sources of Information and Basis for Decision* removed the verbiage, "The development and coverage guidelines in this policy were based on a review of pertinent medical literature, policies from other Medicare contractors, and discussions with appropriate specialists," as this information is redundant since our bibliography is listed.	Provider Education/Guidance Automated Edits to Enforce Reasonable & Necessary Requirements

Associated Documents

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Articles
A56565 - Billing and Coding: Brain Natriuretic Peptide (BNP) Level

Updated On	Effective Dates	Status
06/04/2021	06/10/2021 - N/A	Currently in Effect	You are here
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Brain Natriuretic Peptide (BNP) Level

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