URL for source document:

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=34038&ver=25&bc=0
LCD Title

B-type Natriuretic Peptide (BNP) Testing

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or
dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be
copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without
the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal
purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof,
including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also
contact us at [email protected].

CMS National Coverage Policy

Language quoted from the Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in
interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review a NCD. See §1869(f)(1)(A)(i) of the
Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Title XVIII of the Social Security Act, §1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body
member.

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862(a)(7) excludes routine physical examinations (screening).

1
Code of Federal Regulations:

42 CFR Sections 410.32(a) & 410.32(a)(3) require that clinical laboratory services be ordered and used promptly by the physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who is
treating the beneficiary.

42CFR411.15 excludes from coverage examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury with specific legislative enactments as the only exceptions.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §§20.4.4 and 20.4.5.

CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 9, §100 General Billing Requirements.

CMS Manual System, Pub 100-20, One Time Notification, Transmittal 477, dated April 24, 2009, Change Request 6338.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It is secreted in response to ventricular volume expansion and pressure overload, conditions often present in congestive heart failure (CHF). Used
in conjunction with other clinical information, measurement of BNP levels (either total or N-terminal) is useful in rapidly establishing or excluding the diagnosis or worsening of CHF in patients with acute exacerbation of dyspnea. Also, BNP
levels determined in the first few days after an acute coronary syndrome or event (ACS) may be useful in the prediction of longer-term cardiovascular risk but this risk assessment does not change the management of ACS and is non-covered by
regulation.

Indications:

BNP measurements may be considered reasonable and necessary when used in combination with other medical data such as medical history, physical examination, laboratory studies, and chest x-ray.

• to diagnose or to differentiate heart failure from other potential clinical conditions if the patient s signs and/or symptoms are consistent with both heart failure and one or more other conditions, e.g., acute dyspnea in a patient with
known or suspected pulmonary disease.

• to diagnose or differentiate worsening heart failure if use of the test replaces other diagnostic tests, such as chest film; and/or to confirm the diagnosis when other diagnostic tests are equivocal.

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Limitations:

• BNP measurements must be assessed in conjunction with standard diagnostic tests, medical history and clinical findings. The efficacy of BNP measurement as a stand-alone test has not been established yet.

• BNP measurements for monitoring and management of CHF are non-covered. Treatment guided by BNP has not been shown to be superior to symptom-guided treatment in either clinical or quality-of-life outcomes.

• The efficacy but not the utility of BNP as a risk stratification tool (to assess risk of death, myocardial infarction or congestive heart failure) among patients with acute coronary syndrome (myocardial infarction with or without
T-wave elevation and unstable angina) has been established. However, the assessment of BNP level has not been shown to alter patient management. The BNP is not sufficiently sensitive to either preclude or necessitate any other
evaluation or treatment in this group of patients.

• Screening examinations are statutorily non-covered.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

General Information

Associated Information

Documentation supporting medical necessity must be legible, maintained in the patient's record, and made available to the A/B MAC upon request.

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to,
relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Sources of Information

1. Alehagen U, Dahlström U, Rehfeld JF, Goetze JP. Association of copeptin and N-terminal proBNP concentrations with risk of cardiovascular death in older patients with symptoms of heart failure. JAMA. May 25 2011;305(20):2088-95.
[Medline].

2. Balion C, Don-Wauchope A, Hill S, Santaguida PL, et al. Use of natriuretic peptide measurement in the management of heart failure. Comparative Effectiveness Review No. 126 (Prepared by the McMaster University Evidence-based Practice
Center under Contract No. 290-2007-1060-1.) AHRQ Publication no. 12(14)-EHC118-EF. Rockville, MD: Agency for Healthcare Research and Quality; November 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm

3. Bayes-Genis A, de Antonio M, Galan A, et al. Combined use of high-sensitivity ST2 and NTproBNP to improve the prediction of death in heart failure. Eur J Heart Fail. Jan 2012;14(1):32-8. [Medline].

4. Carpenter CR, Keim SM, Worster A, et al. Brain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role? J Emerg Med. Nov 26 2011;[Medline].

3
5. Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol. Dec 18 2007;50(25):2357-68. [Medline].

6. DeVecchis R, Esposito C, DiBiase G, Ariano C, . et al. B-type natriuretic peptide-guided versus symptom-guided therapy in outpatients with chronic heart failure: a systematic review with meta-analysis. J Cardiovasc Med 2014; 15: 122-134.

7. Doust J, Lehman R, Glasziou P. The Role of BNP Testing in Heart Failure. Am Fam Physician. 2006;74(11):1893-1900.

8. Felker GM, Hasselbad V, Hernandez AF, O Connor CM. Biomarker-guided therapy in chronic heart failure: A meta-analysis of randomized controlled trials. Am Heart J. 2009;158:422-430.

9. Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP
Study. Eur Heart J. . 2006;27(3):330-7. [Medline].

10.Latini R, Masson S, Wong M, et al. Incremental prognostic value of changes in B-type natriuretic peptide in heart failure. American Journal of Medicine. . 2006;119(1):70.e23-30.

11. Le Jemtel TH, Padeletti M, Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. J AM Coll Cardiol. 2007; 49 (2): 171 180.

12. Li P, Luo Y, Chen Y-M. B-type Natriuretic peptide-guided chronic heart failure therapy: A meta-analysis of 11 randomized controlled trials. Heart Lung Circ. 2013;22:852-860.

13. Lindenfeld J, Albert NM, Boehmer JP, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. . Jun 2010;16(6):e1-194. [Medline].

14. MClavel, MaloufJ, MichelenaHI, et al. B-type Natriuretic Peptide Clinical Activation in Aortic Stenosis. J Am Coll Cardiol 2014;63:2016-25

15. Maisel AS, Mueller C, Adams K Jr, et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. . 2008;10(9):824-39.

16. McMurray JJV. Systolic heart failure. N Engl J Med. 2010;362(3):228-238.

17. Pfisterer M, Buser P, Rickli H, et al. BNP-guided vs. symptom-guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in elderly patients with congestive heart failure (TIME-CHF) randomized trial. JAMA. 2009 Jan
28;301(4):383-92.

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18. Porapapkkham P, Zimmet H, Billah B, et al. B-type Natriuretic peptide-guided heart failure therapy: A meta-analysis. Arch Intern Med. . 2010;170:507-514.

19. Ray P, Le Manach Y, Riou B. Houle T. Statistical evaluation of a biomarker. Anesthesiology. 2010; 112:1023-1040. Issue 4

20. Saenger AK, Jaffe AS. The Use of Biomarkers for the Evaluation and Treatment of Patients with Acute Coronary Syndromes. Medical Clinics of North America. . 2007;91(4):657-681.

21. Savarese G, Trimarco B, Dellegrottaglie S, Prastero M, et al. . Natriuretic peptide-guided therapy in chronic heart failure: A meta-analysis of 2,686 patients in 12 randomized controlled trials. PLoS One. 2013;8:e58287.

22. Silvers SM, Howell JM, Kosowsky JM, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Acute Heart Failure Syndromes. Ann Emerg
Med. 2007;49(5):627-669.

23. Troughton RW, Frampton AM. Biomarker-Guided Treatment of Heart Failure. Journal of the American College of Cardiology 2010; 56 (25):2101-2103.

24. Steinhart B, Thorpe KE, Bayoumi AM, Moe G, Januzzi JL Jr, Mazer CD. Improving the diagnosis of acute heart failure using a validated prediction model. J Am Coll Cardiol. Oct 13 2009;54(16):1515-21. [Medline].

25. Wu AH. Serial Testing of B-Type Natriuretic Peptide and NTpro-BNP for Monitoring Therapy of Heart Failure: The Role of Biologic Variation in the Interpretation of Results. American Heart Journal. 2006;152(5):828-834.

26. Yancey CW, Jessup M, Bozkurt B, Butler J, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239.

27. Yardan T, Altintop L, Baydin A, et al. B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism. Int J Clin Pract. Aug 2008;62(8):1177-82. [Medline].

Bibliography

N/A

Revision History Information

Revision
Revision History
History Date Number Revision History Explanation Reasons for Change
10/01/2019 R7 10/01/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a

5
 restriction to the coverage. • Revisions Due To Code Removal

LCD was converted to the "no-codes" format.

10/01/2019 R6 10/01/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a
restriction to the coverage. • Revisions Due To ICD-10-CM
Code Changes
The following codes were added to Group I:

I20.0;121.01;I21.02;I21.09;I21.11;I21.19;I21.21;I21.29;I21.3;I21.4;I21.A1;I21.A9;I22.0

I22.2;I22.8;I22.9; I25.110;I25.700;I25.710;I25.720;I25.730;I25.750;I25.760;I25.790

R06.89;R60.1
10/01/2017 R5 08/21/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a
restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. • Revisions Due To ICD-10-CM
Code Changes
LCD is revised to add the following diagnoses effective 10/01/2017:

I50.810: Right heart failure, unspecified.

I50.811: Acute right heart failure

I50.812: Chronic right heart failure

I50.813: Acute on chronic right hear failure

I50.814: Right heart failure due to left heart failure.

I50.82: Biventricular heart failure

I50.83: High output heart failure

I50.84: End state heart failure

I50.89: Other heart failure

R06.03: Acute Respiratory distress

11/03/2016 R4 This final LCD, effective 10/01/2016, combines JFA L34038 into the JFB LCD so that both JFA and JFB contract numbers will have the same final MCD LCD
number. • Creation of Uniform LCDs
Within a MAC Jurisdiction
10/01/2016 R3 2016-2017 ICD 10 Update to add: I16.0 and I16.1 To Group I codes.
• Revisions Due To ICD-10-CM
Code Changes
10/01/2015 R2 The LCD revised to add I50.9 to the ICD-10 Codes that Support Medical Necessity section effective 10/1/2015.
• Reconsideration Request
10/01/2015 R1 The B-type Natriuretic Peptide (BNP) Testing LCD is revised to incorporate the changes made to the same LCD policy from the JE contract after the comment period
ending 03/14/2014. Updates are made only in the "CMS National Coverage Policy", "Coverage Indications, Limitations and/or Medical Necessity", "Associated • Provider Education/Guidance
Information," and " Sources of Information and Basis for Decision" sections. The effective date of the updates is 07/22/2014. • Creation of Uniform LCDs
Within a MAC Jurisdiction
Associated Documents

Attachments

N/A

6
Related Local Coverage Documents

Articles

A57084 - Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

Related National Coverage Documents

N/A

Public Versions

Updated On Effective Dates Status

09/14/2019 10/01/2019 - N/A Currently in Effect You are here

URL for source document:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57084&ver=11

Article Title

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

Article Type

Billing and Coding

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or
dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be
copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without
the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal
purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof,
including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also
contact us at [email protected].

CMS National Coverage Policy

7
Language quoted from the Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in
interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review a NCD. See §1869(f)(1)(A)(i) of the
Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Title XVIII of the Social Security Act, §1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body
member.

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862(a)(7) excludes routine physical examinations (screening).

Code of Federal Regulations:

42 CFR Sections 410.32(a) & 410.32(a)(3) require that clinical laboratory services be ordered and used promptly by the physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who is
treating the beneficiary.

42CFR411.15 excludes from coverage examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptoms, complaint, or injury with specific legislative enactments as the only exceptions.

CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §§20.4.4 and 20.4.5.

CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 9, §100 General Billing Requirements.

CMS Manual System, Pub 100-20, One Time Notification, Transmittal 477, dated April 24, 2009, Change Request 6338.

Article Guidance

Article Text

8
The following coding and billing guidance is to be used with its associated Local coverage determination.

Documentation supporting medical necessity must be legible, maintained in the patient's record, and made available to the A/B MAC upon request.

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to,
relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)

Group 1 Paragraph

N/A

Group 1 Codes

Code Description
83880 NATRIURETIC PEPTIDE
CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(76 Codes)

Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM (e.g., to the third to seventh character). The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be
reasonable and necessary in the specific case and must meet the criteria specified in this determination.

Group 1 Codes

Code Description
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I16.0 Hypertensive urgency
I16.1 Hypertensive emergency
I20.0 Unstable angina
I20.2 Refractory angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery

9
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.112 Atherosclerosic heart disease of native coronary artery with refractory angina pectoris
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I31.1 Chronic constrictive pericarditis
I42.0 Dilated cardiomyopathy
I42.5 Other restrictive cardiomyopathy
I42.8 Other cardiomyopathies
I50.1 Left ventricular failure, unspecified
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified
I5A Non-ischemic myocardial injury (non-traumatic)

10
J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J45.901 Unspecified asthma with (acute) exacerbation
J98.01 Acute bronchospasm
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.03 Acute respiratory distress
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.82 Tachypnea, not elsewhere classified
R06.89 Other abnormalities of breathing
R60.1 Generalized edema
ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Not Applicable

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types
indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
014x Hospital - Laboratory Services Provided to Non-patients
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
072x Clinic - Hospital Based or Independent Renal Dialysis Center
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other
Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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N/A

Code Description
0300 Laboratory - General Classification
0301 Laboratory - Chemistry
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0523 Freestanding Clinic - Family Practice Clinic
0525 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility
Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation

10/01/2022 R3 The following ICD-10 codes were added to Group 1: I20.2; I25.112, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792.

This revision is due to the annual ICD-10-CM updates effective 10/1/2022.

10/01/2021 R2 Per the 2022 ICD-10 CM annual updates, code I5A was added to Group 1 effective 10/1/2021.
10/01/2019 R1 10/01/2019: Typographical Error - Corrected Code R06.1 to R60.1
Associated Documents

Related Local Coverage Documents

LCDs

L34038 - B-type Natriuretic Peptide (BNP) Testing

Related National Coverage Documents

N/A

Statutory Requirements URLs

N/A

Rules and Regulations URLs

12
N/A

CMS Manual Explanations URLs

N/A

Other URLs

N/A

Public Versions

Updated On Effective Dates Status

09/02/2022 10/01/2022 - N/A Future Effective You are here

13