B-type Natriuretic Peptide (BNP) Local Coverage …

1 B-type Natriuretic Peptide (BNP) Local Coverage Determination CPT Code: 83880 Code Description Hypertensive heart disease with heart failure Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease Hypertensive urgency Hypertensive emergency Chronic constrictive pericarditis Dilated cardiomyopathy Other restrictive cardiomyopathy Other cardiomyopathies Left ventricular failure, unspecified Acute systolic (congestive) heart failure Chronic systolic (congestive)

2 Heart failure Acute on chronic systolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure Right heart failure, unspecified Acute right heart failure Chronic right heart failure Acute on chronic right heart failure Right heart failure due to left heart failure Biventricular heart failure High output heart failure End stage heart failure Other heart failure Heart failure, unspecified Chronic obstructive pulmonary disease with acute lower respiratory infection Chronic obstructive pulmonary disease with (acute) exacerbation Unspecified asthma with (acute)

3 Exacerbation Acute bronchospasm Dyspnea, unspecified Orthopnea Shortness of breath Acute Respiratory distress Other forms of dyspnea Wheezing Tachypnea, not elsewhere classified Medicare Limited Coverage Tests Covered Diagnosis Codes Source: Noridian Solutions, LLC B-type Natriuretic Peptide (BNP) LCD effective October 1, 2017 Effective October 1, 2017 Medicare Limited Coverage Tests