A9611 — Flurpiridaz f 18, diagnostic, 1 millicurie
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without 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.
- 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.
- MPI is covered to identify presence, location, extent, and severity of myocardial ischemia for planning or assessing revascularization (e.g., planning PTCA) and for assessing ischemia or restenosis following PTCA or CABG.
- MPI is covered for assessment of myocardial viability after revascularization or medical management when viability information will direct further treatment.
- MPI may be used in selected patients with acute myocardial infarction (AMI) to assess disease severity, risk/prognosis, efficacy of reperfusion therapy, evidence of myocardial salvage, or when suspected infarction is not diagnostic by history/other tests.
- MPI may be used as an adjunct in unstable angina when history and other tests are nondiagnostic, including identification of ischemia distribution, extent/severity of disease, and measurement of left ventricular function.
9 Active Policies
L33693 — Peripheral Venous Ultrasound
J09
L37371 — Electroretinography (ERG)
J12
L35434 — Oximetry Services
J12
L35451 — Peripheral Venous Ultrasound
J12
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
Related Codes
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