93017
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
$39.08
Non-Facility
$39.08
Documentation Required
- All documentation must be maintained in the patient's medical record, be legible, include complete patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
- Every submitted medical record page must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- If the service provider differs from the ordering/referring physician, the performing provider must maintain hard copy documentation of test results and interpretation plus copies of the ordering/referring physician’s order for the studies.
Key Coverage Criteria
- Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria are met.
- CPT 78434 (gated SPECT) may be reported only in conjunction with CPT 78431 or CPT 78492 when billed for SPECT myocardial perfusion imaging (MPI).
- SPECT MPI includes routine evaluation of left ventricular wall motion and left ventricular ejection fraction (LVEF) as part of the MP1 service definition.
- ICD-10-CM Codes that Support Medical Necessity — Group 1: The following list of ICD-10-CM codes applies to cardiovascular stress testing CPT codes 93015, 93016, 93017, 93018, 93350, 93351 93352 and J0153.
- Since J0395, J1245, and J1250 may be billed for indications other than pharmacological stress agents with cardiovascular testing, the use of these drugs is not subject to the following list of ICD-10-CM diagnoses.
- ICD-10-CM Group 1 covered diagnoses (588 codes) as enumerated in the article under “ICD-10-CM Codes that Support Medical Necessity – Group 1 Codes,” beginning with A18.84 (Tuberculosis of heart) and including, but not limited to, diabetes mellitus complications (E10.10–E10.9, E11.00–E11.9, E13.00–E13.9), lipoprotein disorders (E78.00, E78.010, E78.011, E78.019, E78.2, E78.89), rheumatic/nonrheumatic valvular diseases (I05.x–I06.x, I34.x–I37.x), ischemic heart disease and angina/CAD (I20.1, I20.8 [...]
20 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
L38396 — Cardiology Non-emergent Outpatient Stress Testing
J09
A56952 — Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
J09
L35434 — Oximetry Services
J12
A56423 — Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
Related Codes
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