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), an independent company, for all
Independence 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.
- 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.
- 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 aim_umprograms@ibx.com.
CPT Copyright 2017 American Medical Association. All
rights reserved. CPT? is a registered trademark of the American
Medical Association.