Understanding
BNP Testing

New Medicare Item for BNP Testing

A significant new MBS item for the diagnosis of heart failure was introduced on 1st November 2024. This new item broadens the range of clinical situations in which BNP or NT-proBNP testing can be ordered, going beyond the existing item numbers that are limited to specific conditions or settings (see below).

66829: Quantitation of BNP or NT-proBNP for the exclusion of a diagnosis of heart failure in a patient presenting in a non-hospital setting to assist in decision-making regarding the clinical necessity of an echocardiogram, where heart failure is suspected based on signs and symptoms but diagnosis is uncertain. Applicable once in any 12 month period.

Clinical Utility of BNP Testing

B-type natriuretic peptides (BNP) are primarily synthesised and released by the heart's ventricles in response to ventricular stretch and pressure overload, reflecting myocardial wall tension. This makes BNP an important biomarker for the diagnosis, evaluation, and management of heart failure. It is particularly useful for distinguishing heart failure from other causes of dyspnoea.

Laboratory Diagnostics

Two forms of the test are available: BNP and N-terminal proBNP (NT-proBNP). The precursor protein, ProBNP, is cleaved into BNP and the inactive NT-proBNP.

Elevated levels of BNP or NT-proBNP correlate with the severity of heart failure and may indicate the need for further diagnostic evaluation. NT-proBNP is stable for 3 days in serum and is typically analysed in central laboratories. In contrast, BNP is often used as a point-of-care test. 

In our laboratories, an NT-proBNP level of less than 125 ng/L makes a diagnosis of congestive heart failure unlikely.

Additional MBS Items

Several other MBS items are available for BNP or NTproBNP testing in the diagnosis of heart failure, each with specific restrictions:

• 66830: Quantitation of BNP or NT-proBNP for the diagnosis of heart failure in patients presenting with dyspnoea to a hospital Emergency Department. This test is available up to six times within a 12-month period.
• 66585: Quantification of laboratory-based BNP or NT-proBNP testing in a patient with systemic sclerosis (scleroderma) to assess the risk of pulmonary arterial hypertension, with a maximum of two tests in a 12-month period.
• 66586: Quantification of laboratory-based BNP or NT-proBNP testing in a patient with systemic sclerosis (scleroderma) to assess the risk of pulmonary arterial hypertension, with a maximum of two tests in a 12-month period.

If you enjoyed this article, subscribe to our electronic Pathology Focus newsletter.

Subscribe Today!