As a reminder, effective for commercial HMO, POS, and PPO members in
Pennsylvania and Delaware for dates of
service on or after May 1, 2014, providers now need to obtain precertification
for outpatient echocardiography services,
which include:
- stress echocardiography
- resting transthoracic echocardiography
- transesophageal echocardiography
The CPT® codes to which the precertification applies
are listed in the table below.
Echocardiography service
CPT® code
Description
93350
Transthoracic stress echo, complete
Stress echocardiography (SE)
93351
Transthoracic stress echo, complete w/cont EKG
93303
Transthoracic echo cardiac anomalies
93304
Transthoracic echo cardiac anomalies, limited
93306
Transthoracic echo complete w/color & spectral
93307
Transthoracic echo complete w/o color & spectral
Resting transthoracic echocardiography (TTE)
93308
Transthoracic echo limited
93312
Transesophageal echo
93313
Transesophageal echo probe only
93314
Transesophageal echo interpretation
93315
Transesophageal echo congenital
93316
Transesophageal echo congenital, probe only
Transesophageal echocardiography (TEE)
93317
Transesophageal echo congenital interpretation
93320*
Doppler echo complete
93321*
Doppler echo limited
93325*
Doppler echo flow velocity
Add-on codes
93352*
Echo contrast agent (SE only)
*Denotes a CPT code that is an add-on/secondary code to the primary code and
does not require precertification.
Precertification for outpatient echocardiography services can be obtained
through the NaviNet® web portal using
the AIM Specialty Health® (AIM) ProviderPortalSM. To
do so, select AIM from the Authorizations option in the Plan
Transactions menu.
It is very important that providers use NaviNet to verify member-specific
requirements or refer to the precertification list
on our website. Failure to obtain precertification for any of the services or
drugs
that require it may result in a reduction in payment or nonpayment for the
services not authorized.
Please call 1-800-275-2583 if you have any questions about
this change. For additional information, please refer to Medical Policy
#09.00.46l: High-Technology Radiology Services on our Medical Policy Portal.
Note: These changes went into effect for AmeriHealth New Jersey
commercial and Medicare Advantage HMO members on July 1, 2012, and January 1,
2013, respectively.
AIM is contracted with AmeriHealth to perform precertification for select
diagnostic imaging services for most managed care members.
NaviNet® is a registered trademark of
NaviNet, Inc.
CPT copyright 2012 American Medical Association. All
rights reserved. CPT is a registered trademark of the American Medical
Association.