A9555, Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
- When PET Rb-82 is performed after an equivocal, technically uninterpretable, or discordant SPECT, the clinical reason and medical necessity for PET must be clearly documented in the patient's medical record.
- Baseline cardiac blood pool imaging prior to cardiotoxic chemotherapy requires documentation that no echocardiogram is planned or that prior echocardiogram was uninterpretable.
- Cardiac function monitoring during or after cardiotoxic chemotherapy requires documentation of the chemotherapy agents administered and the clinical indication for monitoring.
Key Coverage Criteria
- Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
- Diagnose CAD in individuals with at least intermediate-risk when PET perfusion imaging is used due to indeterminate or suboptimal noninvasive tests (e.g., indeterminate SPECT or suboptimal body habitus/technical factors).
- Medically necessary for diagnosing CAD in individuals with at least intermediate pretest risk when (a) there are indeterminate noninvasive tests or (b) SPECT is expected to be suboptimal due to body habitus or technical problems.
- Medically necessary for assessing myocardial perfusion to diagnose CAD in individuals with intermediate CAD risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality (e.g., BMI >35 kg/m2, large breasts/implants, prior indeterminate SPECT, prior MI).
- PET scanning is medically necessary to assess myocardial perfusion to diagnose CAD in individuals with intermediate risk when there are indeterminate noninvasive tests or anticipated suboptimal SPECT quality.
- Myocardial perfusion imaging (MPI/SPECT) is covered for diagnosis and management of coronary artery disease (CAD), including evaluation of atypical chest pain, abnormal or suspected false-positive stress ECG, and other symptoms suspicious for CAD.
8 Active Policies
PALMETTO-JJ-L33457, Cardiac Radionuclide Imaging
JJ
PALMETTO-JM-L33457, Cardiac Radionuclide Imaging
JM
BCBSMT-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning
BCBSNM-RAD605.001, Cardiac Applications of Positron Emission Tomography Scanning
BCBSOK-RAD605.001
Related Codes
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