C9763 — Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- For Low-dose CT Chest (CPT® 71271) lung cancer screening: documentation that 'all of the criteria are met' for approval per CH-33/CH-33.1/CH-33.2 / NCD 210.14 (i.e., evidence the patient meets the lung cancer screening criteria referenced).
- For CT Chest without contrast performed for follow-up of pulmonary nodules: documentation/clinical indication supporting prior detection of pulmonary nodule(s) (i.e., justification for follow-up imaging).
- Interrogation report showing device is nearing Elective Replacement Indicator (ERI) or End of Life (EOL).
- Interrogation report documenting the device is not functioning correctly and requires replacement.
Key Coverage Criteria
- CT Chest without contrast (CPT® 71250) can be used for the following: Patient has contraindication to contrast
- CT Chest without contrast (CPT® 71250) can be used for the following: Follow-up of pulmonary nodule(s)
- CT Chest without contrast (CPT® 71250) can be used for the following: High Resolution CT (HRCT)
- Low-dose CT Chest (CPT® 71271) (See CH-33: Lung Cancer Screening)
- Low-dose CT (LDCT) chest for lung cancer screening per CH-33.2: National Coverage Determination (NCD) for Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (210.14) (Medicare)
- Low-dose CT Chest (CPT® 71271) may be approved for lung cancer screening annually if all of the criteria are met.
8 Active Policies
EVICORE-CARDIOVASCULAR_RADIOLOGY-1D1A3C37 — Addendum to the eviCore Imaging Guidelines
ANTHEM-RAD.00068 — RAD.00068 Myocardial Strain Imaging
BCBSIL-RAD601.069 — Myocardial Strain Imaging
BCBSMT-RAD601.069 — Myocardial Strain Imaging
BCBSNM-RAD601.069 — Myocardial Strain Imaging
Related Codes
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