Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Updated information regarding our Cardiology Utilization Management Program

June 11, 2018

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.
    • ? 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 aim_umprograms@ibx.com.

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


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.