Effective for Medicare Advantage HMO and PPO members for dates of service on
or after January 1, 2015, providers
will need to obtain precertification for outpatient echocardiography services,
which 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).
Precertification for outpatient echocardiography services can be obtained
through the NaviNet® web portal using the
AIM ProviderPortalSM. To do so, select the Authorizations
transaction, then AIM.
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 of the
services or drugs that require it 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.