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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2020

Updates to Cardiovascular Disease Risk Tests Medical Policy

Effective for dates of service beginning July 1, 2020 for our commercial members, Harvard Pilgrim is updating our Cardiovascular Disease Risk Tests Medical Policy and will no longer cover the following CPT codes when reported with certain diagnoses:

  • 83880 – Natriuretic peptide
  • 85384 – Fibrogen, activity
  • 0052U – Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of HDL, LDL and VLDL by vertical auto profile ultracentrifugation

In addition, the following tests are being added to the updated policy’s list of coverage exclusions:

  • B-type natriuretic peptide
  • Glycosylated acute phase proteins (GlycA)
  • Interleukin 6, 17, 18
  • Mid-regional pro-atrial natriuretic peptide
  • Molecular lipid/metabolic profiling (e.g., lipidomic, metabolomics)
  • Pregnancy-associated plasma protein-A (PAPP-A)
  • Protein C
  • Prothrombotic factors (antithrombin III, PAI-1, tPA, Factor V Leiden)
  • Soluble cell adhesion molecules (e.g. VCAM-1, ICAM-1)
  • Transforming growth factor beta
  • Troponin

For complete information, please refer to Harvard Pilgrim’s updated Cardiovascular Disease Risk Tests Medical Policy.

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