0439T — Myocrd contrast prfuj echo
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Document the clinical condition or diagnosis that necessitates the echocardiographic procedure in the patient's medical record.
- Document the clinical condition or diagnosis that necessitates administration of a UEA (contrast) in the patient's medical record.
- Document echocardiographic methods employed (including mechanical indices used) and maintain lab accreditation and echocardiographer certification in the record for review if requested.
- Provide medical records when requested; additional letters of support or explanation may be useful but are insufficient alone unless they include all specific information needed to establish medical necessity.
Key Coverage Criteria
- Echocardiography performed with an ultrasound enhancing agent (UEA) for left ventricular opacification (LVO) in the setting of cardiovascular disease is reasonable and medically necessary (FDA‑approved use).
- Echocardiography with UEAs to assess myocardial perfusion is considered reasonable and necessary when evaluating individuals with elevated cardiovascular risk factors who present with symptomatic angina and have known or suspected coronary artery disease (CAD).
- Echocardiography with UEAs to assess myocardial viability for therapeutic or diagnostic decision-making is considered reasonable and necessary.
- Use of FDA‑approved ultrasound enhancing agents (UEAs) for left ventricular opacification (LVO) via IV injection when unenhanced transthoracic echocardiography cannot adequately visualize endocardial borders needed for accurate left ventricular dimensions or volumes.
- Off‑label use of FDA‑approved UEAs for myocardial perfusion or myocardial viability evaluation is recognized and may be addressed for coverage by this LCD (coverage subject to LCD criteria).
2 Active Policies
A58503 — Billing and Coding: Echocardiography for Myocardial Perfusion
L38786 — Echocardiography for Myocardial Perfusion
Related Codes
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