83874
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Providers should reference and use the most up-to-date professional coding guidance (current CPT codes/descriptions) prior to claim submission.
- Provider notification and any required documentation must follow applicable legal and regulatory requirements.
- When state Medicaid coverage provisions conflict with this clinical policy, state Medicaid coverage provisions take precedence; refer to the applicable state Medicaid manual.
- For Medicare members, review all applicable Medicare NCDs, LCDs, and Coverage Articles on the CMS website prior to applying this policy.
Key Coverage Criteria
- Troponin I or T testing is medically necessary for evaluation of suspected acute myocardial infarction (AMI) or myocardial injury from other mechanisms.
- Use cardiac troponin I or T as the preferred biomarker for diagnosis of acute myocardial infarction (AMI) and acute coronary syndromes.
- Use troponin testing to detect myocardial injury in acute and chronic decompensated heart failure when clinically indicated.
- Troponin testing for evaluation of suspected acute myocardial injury/acute coronary syndrome (AMI) due to higher sensitivity and specificity than CK‑MB or myoglobin
- Use of troponin assays as the preferred biomarker for diagnosis of acute coronary syndrome per ACC/AHA guidance
- Cardiac biomarker (troponin) testing for evaluation of acute myocardial infarction (AMI).
1 Active Policy
AMBETTER-CP.MP.156 — Cardiac Biomarker Testing
Related Codes
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