Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

BNP testing is covered when performed for a documented diagnostic indication and claims must include a valid ICD-10-CM diagnosis; as a diagnostic test it is generally limited to four tests per beneficiary per year. BNP testing to monitor CHF is not covered, and monitoring for nesiritide therapy must follow the local coverage policy L33943; proper documentation (provider assessment, history, test results, signed notes), required ABN procedures (Form CMS-R-131, modifiers GA/GX/GZ/GY), and billing/NCCI/OPPS rules must be followed.

"BNP testing is covered when performed as a diagnostic test for a valid, documented clinical indication and the claim includes a valid ICD-10-CM diagnosis code that best describes the patient's cond..."

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