All PlansCoverageMedium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)
Aetna·Cardiology, Internal Medicine, Critical Care +4 more·Medical Policy
We identified it
Oct 7, 2026
Summary
Aetna's Clinical Policy Bulletin 0618 on Brain Natriuretic Peptide (BNP) Testing was reviewed on 2026-09-29 and establishes coverage criteria for BNP/NT-proBNP testing. The policy covers specific medically necessary indications (heart failure differentiation, prognosis assessment, risk stratification, preoperative cardiac risk, and aortic stenosis risk) while classifying all other uses as experimental and investigational. The policy document does not indicate a new effective date; it appears to be a routine review with no stated implementation deadline.
Action Required
Verify current applicability: Billing and clinical teams should review whether Aetna's BNP testing coverage policy (CPB 0618, reviewed 2026-09-29) has been implemented in the practice's billing system and clinical workflows. Confirm that claims for CPT 83880 (Natriuretic peptide) are submitted only for the eight covered indications listed in the policy (heart failure differentiation, chronic heart failure prognosis/severity, heart failure risk assessment, diabetes screening, acute decompensated heart failure assessment, preoperative cardiac risk, and aortic stenosis risk stratification). Ensure that billing staff understand that all other indications—including monitoring therapy effectiveness, titrating therapy, screening for left ventricular dysfunction, and using BNP for diagnoses such as preeclampsia, Kawasaki disease, or pulmonary hypertension—are classified as experimental and investigational and should be denied or require prior authorization. Update billing documentation and encounter forms to capture the specific clinical indication for each BNP order to support medical necessity and avoid claim denials. No source-stated future deadline is provided; confirmation of current implementation is advised.