Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)

Outpatient plasma BNP/NT‑proBNP testing is covered only for specified clinical indications (e.g., distinguishing HF vs pulmonary dyspnea; risk stratification/monitoring in chronic HF including Stage A/B with cardiovascular team input; severe asymptomatic aortic stenosis; transplant-related monitoring including pediatric post‑heart transplant ≤14 when ordered with echo/ECG; suspected amyloidosis or multiple myeloma work‑up; certain elevated‑risk noncardiac surgery scenarios; myocarditis follow‑up; and ICI/immunotherapy surveillance) and is not covered for other uses, including panel/profile screening, targeting therapy to specific biomarker thresholds, or the non‑covered CPT panels (0309U/0310U). Coverage requires documentation of a listed indication, use of the appropriate CPT/ICD‑10 codes (e.g., CPT 83880 when criteria met), and adherence to specific criteria (cardiovascular team involvement for Stage A/B, pediatric post‑transplant testing conditions, MACE risk thresholds for surgery, ICI monitoring parameters); claims without supported codes or documentation will be denied.