Cardiac Biomarker Testing

This policy covers cardiac biomarker testing, designating cardiac troponin I or T as the preferred assay for evaluation and diagnosis of suspected acute myocardial infarction, acute coronary syndromes, and detection of myocardial injury including in acute and chronic decompensated heart failure. Routine CK‑MB and myoglobin testing are considered not medically necessary for AMI/ACS (they do not add diagnostic value), certain CPT codes are not covered when billed with troponin CPT 84484, and coverage is subject to member benefits and applicable legal/regulatory requirements.

"Troponin I or T testing is medically necessary for evaluation of suspected acute myocardial infarction (AMI) or myocardial injury from other mechanisms."

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