Medical Policy Update -- Cardiac Biomakers for Myocardial Infarction

Medical Policy Update -- Cardiac Biomakers for Myocardial Infarction

Cardiac biomarkers are the biochemical markers released in blood from the injured myocardial tissue. They become elevated in blood after a certain period and can be measured. Examples of cardiac biomarkers commonly used in a clinical setting include troponin and creatine kinase MB isoenzyme (CKMB).

Effective Aug. 13, 2018, BlueCross® BlueShield® of South Carolina and BlueChoice HealthPlan will implement a new medical policy addressing the measurement of cardiac biomarkers for diagnosing myocardial infarction in patients presenting with symptoms of acute coronary syndrome (ACS). The policy, CAM 193 – Cardiac Biomarkers for Myocardial Infarction, has been published on the Medical Policies pages of the BlueCross and BlueChoice® websites.

A portion of the policy reads:

Measurement of cardiac troponin (troponin T or I) for the diagnosis of myocardial infarction (Ml) is considered MEDICALLY NECESSARY in all patients presenting with signs and symptoms of acute coronary syndrome.

Measurement of following cardiac biomarkers for the diagnosis and/or prognosis of Ml is NOT MEDICALLY NECESSARY in patients presenting with signs and symptoms of acute coronary syndrome:

  • Aspartate aminotransferase (AST/SGOT)
  • Cardiac creatine kinase isoenzyme MB (CKMB)
  • Creatine kinase (CK)
  • Creatine kinase lsoenzymes
  • Lactate Dehydrogenase (LD, LDH)
  • Myoglobin

Measurement of cardiac biomarkers in patients presenting with signs and symptoms of acute coronary syndrome in an outpatient setting which is not capable of performing adequate clinical Ml evaluation (e.g. independent lab or physician's office) is NOT MEDICALLY NECESSARY.

Measurement of the following cardiac biomarkers for the diagnosis and/or prognosis of Ml is considered INVESTIGATIONAL in patients presenting with signs and symptoms of acute coronary syndrome:

  • Copeptin
  • Troponin C
  • C-reactive protein
  • Heart-type fatty acid binding protein (H-FABP)
  • Any other cardiac biomarkers not listed above

For complete information about CAM 193, visit the medical policies pages in the Provider sections of our websites. You may also contact Provider Education by using the Provider Education Contact Form or by calling 803-264-4730

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.