93654
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
17.65
Facility
$857.40
Non-Facility
$857.40
Documentation Required
- Note on Documentation Requirements: Physicians are reminded to bill the findings of the diagnostic test as the primary indication rather than the referring physician’s diagnosis, as indicated by Medicare’s Diagnostic Imaging Billing guidelines.
- These guidelines are available in the Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures (revised November 2016).
- Policy table headings and entries indicate that CPT and ICD-10 codes are "covered if selection criteria are met" — documentation should support that selection criteria/medical necessity are met (implied requirement).
- Patient age documented (must be >= 18 years for coverage under this policy).
Key Coverage Criteria
- During excision of left atrial mass;
- Evaluation of angina;
- Evaluation of aortic diseases;
- Evaluation of aortocoronary bypass grafts;
- Evaluation of atrial fibrillation/flutter;
- ICD-10 I05.0 - I05.9: Diseases of mitral valve
4 Active Policies
CARELON-transcatheter-ablation-for-supraventricular-and-ventricular-arrhythmias-2024-07-01 — Transcatheter Ablation for Supraventricular and Ventricular Arrhythmias
CIGNA-0529-FUTURE — Cardiac Ablation of Abnormal Electrical Rhythms in Adults - (0529)
AETNA-CPB-0008 — Color-Flow Doppler Echocardiography in Adults
ANTHEM-CG-SURG-55 — CG-SURG-55 Cardiac Electrophysiological Studies (EPS) and Catheter Ablation
Related Codes
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