Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 09101 | First Coast Service Options, Inc. | A and B MAC | FL |
| 09201 | First Coast Service Options, Inc. | A and B MAC | PR VI |
| 09102 | First Coast Service Options, Inc. | A and B MAC | FL |
| 09202 | First Coast Service Options, Inc. | A and B MAC | PR |
| 09302 | First Coast Service Options, Inc. | A and B MAC | VI |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57649 (Billing and Coding: B-Type Natriuretic Peptide (BNP)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57649: Billing and Coding: B-Type Natriuretic Peptide (BNP) (Billing and Coding, effective 2023-10-01)
- Covered ICD-10-CM codes
- 55
- 1 group
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 1
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| I11.0 | — |
| I13.0 | — |
| I13.2 | — |
| I20.0 | — |
| I21.01 | — |
| I21.02 | — |
| I21.09 | — |
| I21.11 | — |
| I21.19 | — |
| I21.21 | — |
| I21.29 | — |
| I21.3 | — |
| I21.4 | — |
| I21.9 | — |
| I21.A1 | — |
| I21.A9 | — |
| I21.B | — |
| I22.0 | — |
| I22.1 | — |
| I22.2 | — |
| I22.8 | — |
| I22.9 | — |
| I50.1 | — |
| I50.20 | — |
Procedure codes: 83880.
Coverage indications, limitations and medical necessity
History/Background and/or General Information
Congestive Heart Failure (CHF) is characterized by a progressive activation of the neurohormonal systems that control vasoconstriction and sodium retention; the activation of these systems plays a role in its pathogenesis and progression. As the heart fails, B-Type Natriuretic Peptide (BNP), a cardiac neurohormone is secreted from the cardiac ventricles in response to ventricular volume expansion and pressure overload. Used in conjunction with other clinical information, rapid measurement of BNP is useful in establishing or excluding the diagnosis and assessment of 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. For the purposes of this LCD, the total and N terminal assays are both acceptable.
Covered Indications
B-Type Natriuretic Peptide (BNP) measurements will be considered medically reasonable and necessary to establish or exclude the diagnosis and assessment of severity of CHF in patients with acute dyspnea when used in combination with other medical data such as medical history, physical examination, laboratory studies, chest x-ray, and electrocardiography (ECG). Rapid measurement of BNP concentration in the blood appears to be a sensitive and specific test for differentiating patients with CHF from primary pulmonary causes of dyspnea in acute care settings.
• Plasma BNP levels are significantly increased in CHF patients with or without concurrent lung disease compared with patients with primary lung disease.
• Plasma BNP levels are significantly increased in CHF patients presenting with acute dyspnea compared with patients presenting with acute dyspnea due to other causes.
• BNP levels are also useful for risk stratification (to assess risk of death, myocardial infarction or congestive heart failure) among patients with acute coronary syndrome (myocardial infarction with or without T-wave elevation and unstable angina).
Limitations
BNP measurements must be analyzed in conjunction with standard diagnostic tests, the medical history, and clinical findings; its efficacy as a stand-alone test has not yet been established.
Additional investigation is required to further define the diagnostic value of plasma BNP in monitoring the efficiency of treatment for CHF and in tailoring the therapy for heart failure. Therefore, BNP measurements for monitoring and management of CHF are not a covered service.
Generally, it is not expected that this test would be performed more than four times in a year.
BNP measurements are not a covered service when performed as a routine screening procedure, in the absence of documentation of clinical findings in the patient’s medical record indicating suspected CHF, or for monitoring and management of CHF.
As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual , Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2019-01-08
- Last reviewed by the contractor
- 2018-07-25
- MCD version
- 17
- Derived from
- L28772
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the First Coast Service Options, Inc. hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L33267 cover?
Congestive Heart Failure (CHF) is characterized by a progressive activation of the neurohormonal systems that control vasoconstriction and sodium retention; the activation of these systems plays a role in its pathogenesis and progression. As the heart fails, B-Type Natriuretic Peptide (BNP), a cardiac neurohormone is secreted from the cardiac ventricles in response to ventricular volume expansion and pressure… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L33267 apply to?
First Coast Service Options, Inc. applies it to Medicare claims in FL, PR, VI. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L33267?
The companion billing and coding article A57649 lists 55 ICD-10-CM codes in 1 group that support medical necessity and 1 that do not; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L33267?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.