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Upcoming changes to our precertification process for outpatient echocardiography services for Medicare Advantage HMO and PPO members

October 1, 2014

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

Transesophageal echo

Transesophageal echo probe only

Transesophageal echo interpretation

Transesophageal echo congenital

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 NaviNet® using the AIM ProviderPortalSM. To do so, select AIM from the Authorizations option in the Plan Transactions menu.

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.

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

CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


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