Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028) — MM 0028 | CIGNA Coverage Update

Cigna modified MM 0028 covering BNP and NT-proBNP testing in the outpatient setting, effective October 16, 2025. Here's what billing teams need to know before that date.

Cigna Healthcare updated coverage policy MM 0028, which governs plasma brain natriuretic peptide (BNP) and NT-proBNP measurement in outpatient settings. The change affects three CPT codes — 83880, 0309U, and 0310U — and spans 139 ICD-10-CM diagnosis codes covering cardiovascular disease, diabetes, hypertension, valve disorders, and more. If your practice bills these markers for heart failure evaluation, Kawasaki disease workup, or cardiovascular risk assessment, this policy change is your roadmap for what Cigna will and won't pay.

Quick-Reference Table

Cigna BNP and NT-proBNP Coverage Criteria and Medical Necessity Requirements 2025

The Cigna BNP coverage policy under MM 0028 covers CPT 83880 (natriuretic peptide), CPT 0309U, and CPT 0310U when medical necessity criteria are met. All three codes are designated "Considered Medically Necessary when criteria in the applicable coverage position are met." That's standard Cigna language — but the real work is in the diagnosis pairing.

Cigna requires a supported ICD-10-CM diagnosis to establish medical necessity for BNP and NT-proBNP billing. With 139 covered diagnosis codes, the list is broad — but that breadth cuts both ways. It means there's no excuse for missing a valid indication, and there's no room for sloppy code selection when the patient's chart supports a more specific code.

The three CPT codes serve different clinical purposes, and Cigna treats them differently in practice. CPT 83880 is the standard natriuretic peptide assay — the workhorse of outpatient heart failure diagnosis and monitoring. CPT 0309U is a proprietary multianalyte assay for cardiovascular disease risk, analyzing four proteins; the source description identifies NT-proBNP and osteopontin among them. Consult the full MM 0028 policy for the complete panel composition before billing. CPT 0310U is a pediatric-specific panel for Kawasaki disease evaluation. The source description identifies NT-proBNP and C-reactive protein among the biomarkers analyzed; consult the full policy for the complete biomarker list.

Misrouting a pediatric KD workup through CPT 83880 instead of CPT 0310U — or billing the multianalyte panel 0309U when only a standalone BNP was ordered — is a direct path to claim denial. Get the CPT-to-clinical-indication match right before submission.

Regarding prior authorization: MM 0028 does not explicitly call out a prior authorization requirement for BNP testing in the outpatient setting under this policy. However, prior auth requirements can live at the plan level, not just the coverage policy level. If your patients are on managed care or ACA exchange plans administered by Cigna, verify auth requirements through eligibility checks before the first bill goes out.

Cigna BNP Testing Exclusions and Non-Covered Indications

MM 0028 does not list a separate "not covered" or "experimental/investigational" designation for BNP or NT-proBNP testing under the three affected codes. All three codes carry a single coverage position: medically necessary when criteria are met. There is no bifurcation into covered vs. experimental tiers within this policy.

The real risk here isn't an explicit exclusion — it's a diagnosis mismatch. If you bill CPT 83880 with a diagnosis code that isn't on Cigna's supported ICD-10-CM list for this policy, you're looking at a medical necessity denial, not a coverage exclusion. That's an important distinction. A coverage exclusion is harder to overturn. A medical necessity denial has an appeal path — but it's also avoidable if your coding team validates the diagnosis pairing at charge capture.

Coverage Indications at a Glance

Cigna BNP Billing Guidelines and Action Items 2025

If your practice has high volume on any of these codes and you're uncertain how the updated criteria map to your patient mix, loop in your compliance officer before October 16.

CPT, HCPCS, and ICD-10 Codes for BNP and NT-proBNP Testing Under MM 0028

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM list under MM 0028 includes 139 codes. The 59 additional codes cover further cardiac, renal, and systemic diagnoses. Access the complete list at the Cigna MM 0028 policy page.