72159
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
1.76
Facility
$11.23
Non-Facility
$11.23
Documentation Required
- For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
- A valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed must be reported on the claim; claims without a valid code will be returned as incomplete.
- For diagnostic MRA tests, report the result of the test if known; if not known, report the symptoms that prompted the test.
- The patient's medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Key Coverage Criteria
- MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
- MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
- MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
- MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.
- MRA of the chest is covered for diagnosis of suspected pulmonary embolism when the patient has a contraindication to receiving intravascular iodinated contrast material.
- MRA of the chest is covered for pre-operative and post-operative evaluation of thoracic aortic dissection and thoracic aortic aneurysm and may be used as an alternative to other non-invasive imaging when clinically appropriate.
15 Active Policies
A56747 — Billing and Coding: Magnetic Resonance Angiography (MRA)
J06
L33633 — Magnetic Resonance Angiography (MRA)
J06
L33693 — Peripheral Venous Ultrasound
J09
L37371 — Electroretinography (ERG)
J12
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
Related Codes
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