We previously notified you about new utilization management requirements for our Cardiology Utilization Management Program that includes cardiovascular tests/diagnostic procedures and nonsurgical treatments for obstructive coronary artery disease. Utilization management review for these services is delegated to AIM Specialty Health^? (AIM) for all AmeriHealth members.

Please note that the following services/Current Procedural Terminology (CPT^?) codes will be reviewed post-service in accordance with AIM?s clinical criteria:

• Duplex Scan Lower Extremity Arteries ? Must be reported to AIM prior to claims submission and within ten business days following physiologic testing for peripheral artery disease (PAD). The physiologic test results must be available when contacting AIM.
  • ? 93925
  • ? 93926
• Duplex Scan Upper Extremity Arteries ? Must be reported to AIM prior to claims submission and within ten business days following physiologic testing for PAD. The physiologic test results must be available when contacting AIM.
  • ? 93930
  • ? 93931
• Percutaneous Coronary Intervention (PCI) ? Must be reported to AIM prior to claims submission and within ten business days following diagnostic coronary angiography. The diagnostic coronary angiography results and relevant clinical information must be available when contacting AIM.
  • ? 92920, 92921
  • ? 92924, 92925
  • ? 92928, 92929
  • ? 92933, 92934
  • ? 92937, 92938
  • ? 92943, 92944

• Exception: When the results of the coronary angiogram are known and the coronary angiogram and PCI are not performed at the same time, precertification/preapproval of the PCI must be obtained prior to the service being performed.

If you have any questions, please send an email to aimumprograms@amerihealth.com.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT^? is a registered trademark of the American Medical Association.