Biomarkers in Risk Assessment and Management of Cardiovascular Disease

Policy ID: L-96-016

Section: Laboratory

Effective Date: July 01, 2018

Revised Date: November 21, 2024

Revision Effective Date: January 06, 2025

Last Reviewed: November 19, 2024

Applies To: Commercial and Medicaid Expansion

Description

Numerous lipid and nonlipid biomarkers have been proposed as potential risk markers for cardiovascular disease. This policy will focus on those lipid markers that have the most evidence in support of their use in clinical care. The biomarkers assessed here are apolipoprotein B (apo B), apolipoprotein AI (apo AI), apolipoprotein E (apo E), B-type natriuretic peptide, cystatin C, fibrinogen, high-density lipoprotein (HDL) subclass, leptin, low-density lipoprotein (LDL) subclass, and lipoprotein A.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date; and/or

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Measurement of novel lipid and non-lipid risk factors (i.e., apolipoprotein B, apolipoprotein A-I, apolipoprotein E, B-type natriuretic peptide, cystatin C, leptin, LDL subclass, HDL subclass, lipoprotein[a]) are considered experimental/investigational and, therefore, non-covered, as an adjunct to LDL cholesterol in the risk assessment and management of cardiovascular disease. The available scientific evidence does not provide adequate data to establish that the use of panels that include lipid and non-lipid cardiovascular risk markers improve outcomes when used in clinical care.

Procedure Codes

82172

82610

83520

83695

83698

83700

83701

83704

83719

83722

83880

0052U

0119U

Policy Application

The measurement of plasma brain natriuretic peptide (BNP) or NT-proBNP may be medically necessary for ANY ONE of the following indications:

Differentiating heart failure from pulmonary disease in a dyspneic individual; or
Monitoring response to treatment for heart failure; or
Risk stratification in a suspected acute coronary syndrome (ACS).

The measurement of plasma brain natriuretic peptide (BNP) or NT-proBNP testing for any other indication is considered experimental/investigational and, therefore, non-covered. Scientific evidence of safety and efficacy has not been proven.

Procedure Code

83880

Diagnosis Codes

Covered Diagnosis Codes for procedure code 83880

I20.0

I21.01

I21.02

I21.09

I21.11

I21.19

I21.21

I21.29

I21.3

I21.4

121.9

I21.A1

I21.A9

I22.0

I22.1

I22.2

I22.8

I22.9

I24.0

I24.9

I25.110

I25.700

I25.710

I25.720

I25.730

I25.750

I25.760

I25.790

I27.0

I27.20

I27.21

I27.22

I27.23

I27.24

I27.29

I27.83

I31.1

I42.0

I42.1

I42.2

I42.3

I42.4

I42.5

I42.6

I42.7

I42.8

I42.9

I43

I50.1

I50.20

I50.21

I50.22

I50.23

I50.30

I50.31

I50.32

I50.33

I50.40

I50.41

I50.42

I50.43

I50.810

I50.812

I50.813

I50.814

I50.82

I50.83

I50.84

I50.9

I92.9

J90

J91.8

J92.0

J94.1

J94.8

J94.9

J96.00

J96.01

J96.02

J96.20

J96.21

J96.22

J96.90

J96.91

J96.92

R06.00

R06.01

R06.02

R06.03

R06.09

R06.2

R06.3

R06.4

R06.81

R06.82

R06.83

R06.89

R06.9

R07.1

R07.2

R07.81

R07.82

R07.89

R07.9

R60.0

R60.1

R60.9

Non-covered Diagnosis Codes for procedure codes 82172, 83695, 83698, 83700, 83701, 83704, 83719, and 83722:

Z13.220

Z13.6

Z82.49

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 11-14-2019 Update to v14, addition of non-covered code, verified diagnosis codes.

Internal Medical Policy Committee 3-16-2020 No changes in policy-Annual Review Updated to version 015

Internal Medical Policy Committee 5-20-2021 Annual Review-no changes in Criteria

Internal Medical Policy Committee 5-24-2022 Annual Review-no changes in criteria

Internal Medical Policy Committee 5-23-2023 Annual Review-no changes in criteria

Internal Medical Policy Committee 7-21-2023 Coding update- Effective July 21, 2023

Removed diagnosis code I80.89; and
Added diagnosis codes I21.9; I24.0; I24.9; I42.4; I92.9; J92.0; R06.4; R06.81; R60.1; and R60.9

Internal Medical Policy Committee 9-17-2024 Coding update - Effective November 04, 2024

Removed diagnosis codes I50.510; and I24.8; and
Added Policy Application

Internal Medical Policy Committee 11-19-2024 Annual Review-no changes in criteria

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: L-96-016

Section: Laboratory

Effective Date: July 01, 2018

Revised Date: July 21, 2023

Revision Effective Date: July 21, 2023

Last Reviewed: July 26, 2023

Archived Date: November 03, 2024

Applies To: Commercial and Medicaid Expansion

Description

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Procedure Codes

82172

82610

83520

83695

83698

83700

83701

83704

83719

83722

83880

0052U

0119U

The measurement of plasma brain natriuretic peptide (BNP) or NT-proBNP may be medically necessary for ANY ONE of the following indications:

Differentiating heart failure from pulmonary disease in a dyspneic individual; or
Monitoring response to treatment for heart failure; or
Risk stratification in a suspected acute coronary syndrome (ACS).

Procedure Code

83880

Diagnosis Codes

Covered Diagnosis Codes for procedure code 83880

I20.0

I21.01

I21.02

I21.09

I21.11

I21.19

I21.21

I21.29

I21.3

I21.4

121.9

I21.A1

I21.A9

I22.0

I22.1

I22.2

I22.8

I22.9

I24.0

I24.9

I25.110

I25.700

I25.710

I25.720

I25.730

I25.750

I25.760

I25.790

I27.0

I27.20

I27.21

I27.22

I27.23

I27.24

I27.29

I27.83

I31.1

I42.0

I42.1

I42.2

I42.3

I42.4

I42.5

I42.6

I42.7

I42.8

I42.9

I43

I50.1

I50.20

I50.21

I50.22

I50.23

I50.30

I50.31

I50.32

I50.33

I50.40

I50.41

I50.42

I50.43

I50.510

I50.810

I50.812

I50.813

I50.814

I50.82

I50.83

I50.84

I50.9

I92.9

J90

J91.8

J92.0

J94.1

J94.8

J94.9

J96.00

J96.01

J96.02

J96.20

J96.21

J96.22

J96.90

J96.91

J96.92

R06.00

R06.01

R06.02

R06.03

R06.09

R06.2

R06.3

R06.4

R06.81

R06.82

R06.83

R06.89

R06.9

R07.1

R07.2

R07.81

R07.82

R07.89

R07.9

R60.0

R60.1

R60.9

Non-covered Diagnosis Codes for procedure codes 82172, 83695, 83698, 83700, 83701, 83704, 83719, and 83722:

Z13.220

Z13.6

Z82.49

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 11-14-2019 Update to v14, addition of non-covered code, verified diagnosis codes.

Internal Medical Policy Committee 3-16-2020 No changes in policy-Annual Review Updated to version 015

Internal Medical Policy Committee 5-20-2021 Annual Review-no changes in Criteria

Internal Medical Policy Committee 5-24-2022 Annual Review-no changes in criteria

Internal Medical Policy Committee 5-23-2023 Annual Review-no changes in criteria

Internal Medical Policy Committee 7-21-2023 Coding update- Effective July 21, 2023

Removed diagnosis code I80.89
Added diagnosis codes I21.9, I24.0, I24.9, I42.4, I92.9, J92.0, R06.4, R06.81, R60.1, and R60.9

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