93613
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
5.10
Facility
$247.83
Non-Facility
$247.83
Documentation Required
- No explicit documentation requirements (required medical records, test results, or clinical documentation) are present in the provided document text.
- Refer to CMS Medicare Coverage Database for the most current applicable CMS National Coverage Determination (NCD)/Local Coverage Determination (LCD)/Local Coverage Article (LCA).
- Refer to the CMS website for the most current applicable CMS Online Manual System (IOMs) and Transmittals.
- See related Humana Medicare Advantage Medical/Pharmacy Coverage Policies: Cardiac Catheterization and Coronary Angiography; Cardiac Pacemakers; Cardioverter Defibrillators/Cardiac Resynchronization Therapy.
Key Coverage Criteria
- 93799: Unlisted cardiovascular service or procedure
- PulseSelect is FDA approved for persistent atrial fibrillation when episode duration is less than one year.
- Atrioventricular node ablation (AVNA) to treat arrhythmias such as atrial fibrillation (AF).
- AVNA performed to control ventricular rate in an individual with persistent atrial arrhythmia accompanied by rapid ventricular response.
- None — the document describes cardiac focal ablation using radiation therapy (stereotactic arrhythmia radioablation, STAR) as an investigational therapy for ventricular tachycardia (VT) resistant to antiarrhythmic medication or when conventional catheter ablation techniques are ineffective or contraindicated.
- Electrophysiologic mapping to precisely identify the area within the heart that is triggering an arrhythmia (inferred from text).
3 Active Policies
CARELON-electrophysiological-studies-2024-07-01 — Electrophysiological Studies
HUMANA-CARDIAC-ELECTROPHYSIOLOGICAL-STUDIES-AND-CARDIAC-CATHETER-ABLATION-MA — Cardiac Electrophysiological Studies and Cardiac Catheter Ablation - Medicare Advantage
ANTHEM-CG-SURG-55 — CG-SURG-55 Cardiac Electrophysiological Studies (EPS) and Catheter Ablation
Related Codes
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