0866T — Quan mri alys brn w/dx mri
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
- When a referring/ordering physician is required, the referring/ordering physician's name and NPI must be reported on the claim.
- Diagnosis code(s) must best describe the patient condition for which the service was performed; for diagnostic tests, report the test result if known or otherwise report the symptoms prompting the test.
- Non-covered services should be billed with the appropriate modifier (-GA, -GX, -GY, or -GZ) per CMS Publication 100-04 Chapter 30; use an ABN (Form CMS-R-131) when applicable.
- When using modifier GA to indicate beneficiary accepted financial responsibility, an ABN Form CMS-R-131 should be signed by the beneficiary; for Part A MAC claims using GA, occurrence code 32 and the ABN date are required.
Key Coverage Criteria
- Primary brain MRI procedure codes 70551, 70552, and 70553 are eligible for Medicare payment when billed according to Medicare billing rules.
- Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
- Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
- Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
- Perform venous ultrasound to evaluate postthrombotic (postphlebitic) syndrome in patients with symptoms consistent with PTS (e.g., chronic leg pain, heaviness, swelling, itching, or leg ulcers).
- Perform venous ultrasound to evaluate suspected valvular incompetence in patients with symptomatic chronic venous insufficiency or symptomatic varicose veins when the result will confirm diagnosis prior to treatment.
13 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
J12
L35007 — Vestibular and Audiologic Function Studies
J12
L35434 — Oximetry Services
J12
L35451 — Peripheral Venous Ultrasound
Related Codes
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