CommercialCoverageMedium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-01-27)
Aetna·Cardiology, Internal Medicine, Endocrinology +4 more·Medical Policy
Effective date
Jan 27, 2026
We identified it
Aug 14, 2026
Summary
Aetna has updated its Brain Natriuretic Peptide (BNP) testing policy (CPB 0618) to clarify covered and non-covered indications. BNP testing (CPT 83880) is covered only for specific heart failure-related indications, while serial measurements and most other uses are classified as experimental/investigational. Billing teams must verify medical necessity against the approved indications list before processing claims to avoid denials.
Action Required
By February 15, 2026: Billing team must update claims processing system to implement prior authorization requirements for CPT 83880 (Natriuretic peptide testing) under Aetna plans. Review all pending and in-progress BNP claims to verify they match one of the five covered indications: (1) differentiate dyspnea due to heart failure vs. pulmonary disease, (2) determine prognosis/severity in chronic heart failure, (3) assess heart failure risk in persons with cardiovascular risk factors, (4) annual screening for heart failure in diabetic adults, or (5) hospital admission assessment for acute decompensated heart failure. Flag all other uses (serial measurements, stress testing, preeclampsia screening, mechanical ventilation weaning, etc.) as non-covered experimental/investigational. Update encounter templates and provider communication to highlight the five covered indications. Providers must document which specific indication applies on each requisition. All claims submitted without matching covered criteria will be denied. Cardiology and internal medicine providers require immediate notification of policy scope.