COVID-19 (Coronavirus): Pharmacologic nuclear stress testing

July 30, 2020

This article was revised on July 30, 2020, to update the effective timeline.

AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members and providers to visit our dedicated AmeriHealth New Jersey and AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

Stress testing coverage

Effective March 6, 2020, through September 4, 2020, a pharmacologic stress test using nuclear imaging is covered in lieu of a cardiovascular stress test using treadmill or bicycle exercise with continuous electrocardiographic monitoring, when a stress test is medically necessary and cannot be deferred. This coverage decision is subject to re-evaluation for the duration of the public health emergency.

AmeriHealth recognizes the risk of disease exposure that a cardiovascular stress test using treadmill or bicycle exercise may pose during the COVID-19 public health emergency.

These tests should generally be deferred when non-urgent, in accordance with the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). When a cardiovascular test cannot be deferred, it should be converted to a pharmacologic stress test using nuclear imaging.

Conversion to a pharmacologic stress test using nuclear imaging may minimize the risk of viral exposure and transmission to health care personnel and individuals during the COVID-19 pandemic.

AIM guidelines

For AmeriHealth plans that are subject to radiology utilization management through AIM Specialty Health® (AIM) for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services, AIM will apply the above coverage criteria to determine the medical necessity for these services.

To view AIM’s current and future guidelines, go to the Resources section of AIM’s website.

Coding and policy

Please review the AmeriHealth policy announcement for a list of eligible procedure codes.

Policy #09.00.46ab: High-Technology Radiology Services (AmeriHealth) is affected by this change.

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources: