As previously communicated, effective for dates of service on or after January 1, 2013, providers need to obtain prior authorization for AmeriHealth 65 NJ HMO and AmeriHealth 65 Preferred HMO members for cardiac radiology services, which include: stress echocardiography resting transthoracic echocardiography transesophageal echocardiography This requirement does not apply to studies performed in the emergency room or during an inpatient or observation unit stay. Specific CPT^? codes to which the prior authorization requirement 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) This change has been made to align Medicare Advantage HMO prior authorization requirements to those already in place for AmeriHealth New Jersey commercial members. It is very important that providers use the NaviNet^? web portal to verify member-specific requirements or refer to the precertification lists. Failure to obtain prior authorization 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 Customer Service at 1-800-275-2583 if you have any questions about this change.

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