B-type Natriuretic Peptide (BNP) Testing

BNP testing is covered when used alongside other clinical information to diagnose or differentiate acute or worsening congestive heart failure—particularly in patients with acute dyspnea or when other diagnostic tests are equivocal or replaced by BNP. BNP testing is not covered for routine monitoring/management of CHF, for asymptomatic screening, or for risk stratification after acute coronary syndromes because it has not been shown to change patient management; BNP should not be used as a stand-alone test but must be interpreted with standard diagnostic data.

"BNP measurement is reasonable and necessary, used in combination with medical history, physical examination, laboratory studies, and chest x-ray, to diagnose or differentiate congestive heart failu..."

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