Biomarkers in Risk Assessment and Management of Cardiovascular Disease

Section: Laboratory
Effective Date: July 01, 2018
Revised Date: March 16, 2020
Last Reviewed: March 16, 2020

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.

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

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).

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 Codes

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 I21.A1 I21.A9 I22.0 I22.1
I22.2 I22.8 I22.9 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 I42.5 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 I80.89 J90 J91.8 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 R06.82 R06.83 R06.89 R06.9
R07.1 R07.2 R07.81 R07.82 R07.89 R07.9 R60.0
R60.1            

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

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.