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Precertification requirement for outpatient echocardiography services for Medicare Advantage HMO and PPO members now in effect

December 30, 2014

As of January 1, 2015, providers are required to obtain precertification through the AIM ProviderPortalSM for outpatient echocardiography services for Medicare Advantage HMO and PPO members. These services include:

  • stress echocardiography;
  • resting transthoracic echocardiography;
  • transesophageal echocardiography.

Specific CPT® codes to which the precertification applies are listed in the table below:

Echocardiography service CPT® code Description Stress echocardiography (SE) 93350

93351 Transthoracic stress echo, complete

Transthoracic stress echo, complete w/cont EKG Resting transthoracic echocardiography (TTE) 93303

93304

93306

93307

93308 Transthoracic echo cardiac anomalies

Transthoracic echo cardiac anomalies, limited

Transthoracic echo complete w/color & spectral

Transthoracic echo complete w/o color & spectral

Transthoracic echo limited Transesophageal echocardiography (TEE) 93312

93313

93314

93315

93316

93317 Transesophageal echo

Transesophageal echo probe only

Transesophageal echo interpretation

Transesophageal echo congenital

Transesophageal echo congenital, probe only

Transesophageal echo congenital interpretation

Add-on codes 93320*

93321*

93325*

93352* Doppler echo complete

Doppler echo limited

Doppler echo flow velocity

Echo contrast agent (SE only)

*Denotes a CPT® code that is an add-on/secondary code to the primary code and does not require review through AIM Specialty Health® (AIM).

To request precertification for these services, providers should select the Authorizations transaction on the NaviNet® web portal, then AIM to access the AIM Provider Portal.

It is very important that providers use NaviNet to verify member-specific requirements or refer to the precertification lists on our website. Failure to obtain precertification for any required services or drugs may result in a reduction in payment or nonpayment for the services not authorized.

AIM is an independent company contracted with Independence to perform precertification for select services for most managed care members.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


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