M1150, Current or prior left ventricular ejection fraction (lvef) less than or equal
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
- Medical record documentation of medical necessity is required for frequency of TTE examinations exceeding generally accepted intervals (e.g., more frequently than annually) and for uses in excess of typical transplant or prosthetic valve surveillance.
- A complete TTE study requires image acquisition, measurement/analysis, physician interpretation, and a written report prepared for the patient’s record.
- Stress ECHO interpretation requires a computer-based digitized imaging technique for study interpretation.
- When dipyridamole is used, aminophylline must be available to reverse ischemia if it occurs (operational requirement for safe administration).
Key Coverage Criteria
- Contrast echocardiography is covered to evaluate myocardial ischemia, quantify myocardial perfusion during stress, identify the area at risk during acute myocardial infarction, determine success of reperfusion interventions, and assess myocardial viability.
- Transthoracic echocardiogram (TTE) is covered to evaluate ventricular function and cardiomyopathies in individuals with signs and/or symptoms suggestive of ventricular dysfunction.
- TTE is covered for hypertensive cardiovascular disease when hypertension is accompanied by clinical evidence of heart disease (HTN alone without signs/symptoms is not covered).
- TTE is covered for evaluation and complication assessment in acute myocardial infarction and coronary insufficiency when clinical findings indicate myocardial dysfunction.
- In patients exposed to cardiotoxic agents, baseline TTE, bimonthly monitoring during therapy, and assessment at 6 months post-therapy are medically appropriate.
- TTE is covered as part of donor selection and serial monitoring following cardiac transplant (typically weekly for the first 4–8 weeks, then decreasing frequency; about 2 studies/year in stable chronic recipients).
2 Active Policies
PALMETTO-JJ-L37379, Echocardiography
JJ
PALMETTO-JM-L37379, Echocardiography
JM
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