Effective for commercial HMO, POS, and PPO members in Pennsylvania and Delaware for dates of service on or after May 1, 2014, providers will need to obtain precertification for outpatient echocardiography services, which include:

• stress echocardiography
• resting transthoracic echocardiography
• transesophageal echocardiography

Note: These requirements went into effect for AmeriHealth New Jersey commercial and Medicare Advantage HMO members on July 1, 2012, and January 1, 2013, respectively.

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) ProviderPortal^SM. 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 upcoming change.

AIM is contracted with AmeriHealth to perform precertification for select diagnositc imaging services for most managed care members.

NaviNet^® is a registered trademark of NaviNet, Inc.