CMS Brain Natriuretic Peptide (BNP) Level Form

Summary Of Evidence

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Analysis of Evidence

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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, factors often found in congestive heart failure (CHF). Used in conjunction with other clinical information, rapid measurement of BNP is useful in establishing or excluding the diagnosis and assessing the severity of CHF in patients with acute dyspnea, so that appropriate and timely treatment can be initiated. This test is also used to predict the long-term risk of cardiac events or death across the spectrum of acute coronary syndromes, when measured in the first few days after an acute coronary event.

Indications:

1. BNP measurements are used to distinguish cardiac cause of acute dyspnea from pulmonary or other non-cardiac causes.

2. BNP is particularly useful in distinguishing decompensated CHF from exacerbated chronic obstructive pulmonary disease (COPD) in a symptomatic patient with combined CHF and COPD.

3. BNP is a risk stratification tool used to assess risk of death, myocardial infarction or CHF among patients with acute coronary syndrome (myocardial infarction with or without T-wave elevation and unstable angina).

4. Routine assays of BNP can be used to assess the effectiveness of CHF therapy and for titration of heart failure therapy.

Limitations:

1. Measurement of BNP as part of cardiovascular risk assessment panels, consisting of various combinations of biochemical, immunologic, hematologic and molecular tests is considered a screening when performed on an asymptomatic patient and is not a Medicare benefit. Refer to the MolDX: Biomarkers in Cardiovascular Risk Assessment L36129 Local Coverage Determination (LCD).

2. Routine assays of only BNP to screen for the development of left ventricular dysfunction or new onset Heart Failure in asymptomatic patients is not covered due to statutory limitations.