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2015
MEDICARE LOCAL COVERAGE DETERMINATION (LCD) - L35526
CPT CODES: 83880
B-TYPE NATRIURETIC PEPTIDE (BNP)
42833
57748
DLS TEST CODE AND NAME
B-NATRIURETIC PEPTIDE
NT proBNP
DESCRIPTION
ICD-10 CODE
I11.0
I13.0
I13.2
I31.1
I42.0
I42.5
I42.8
I50.1
I50.21
I50.22
I50.23
I50.31
I50.32
I50.33
I50.41
I50.42
I50.43
I50.9
J44.0
J44.1
J45.901
J98.01
R06.00
R06.01
R06.02
R06.09
R06.2
R06.82
Hypertensive heart disease with heart failure
Hypertensive heart and chronic kidney disease with heart failure and stage 1 through
stage 4 chronic kidney disease, or unspecified chronic kidney disease
Hypertensive heart and chronic kidney disease with heart failure and with stage 5
chronic kidney disease, or end stage renal disease
Chronic constrictive pericarditis
Dilated cardiomyopathy
Other restrictive cardiomyopathy
Other cardiomyopathies
Left ventricular failure
Acute systolic (congestive) heart failure
Chronic systolic (congestive) heart failure
Acute on chronic systolic (congestive) heart failure
Acute diastolic (congestive) heart failure
Chronic diastolic (congestive) heart failure
Acute on chronic diastolic (congestive) heart failure
Acute combined systolic (congestive) and diastolic (congestive) heart failure
Chronic combined systolic (congestive) and diastolic (congestive) heart failure
Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
Heart failure, unspecified
Chronic obstructive pulmonary disease with acute lower respiratory infection
Chronic obstructive pulmonary disease with (acute) exacerbation
Unspecified asthma with (acute) exacerbation
Acute bronchospasm
Dyspnea, unspecified
Orthopnea
Shortness of breath
Other forms of dyspnea
Wheezing
Tachypnea, not elsewhere classified
Source: www.cms.hhs.gov/mcd
Effective Date: 10-1-2015
REVISED 10-9-2015
B-type Natriuretic Peptide
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