Q9950 — Injection, sulfur hexafluoride lipid microspheres, per ml
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
- Document the clinical condition or diagnosis that necessitates the echocardiographic procedure in the patient's medical record.
- Document the clinical condition or diagnosis that necessitates administration of a UEA (contrast) in the patient's medical record.
- Document echocardiographic methods employed (including mechanical indices used) and maintain lab accreditation and echocardiographer certification in the record for review if requested.
- Provide medical records when requested; additional letters of support or explanation may be useful but are insufficient alone unless they include all specific information needed to establish medical necessity.
Key Coverage Criteria
- Echocardiography performed with an ultrasound enhancing agent (UEA) for left ventricular opacification (LVO) in the setting of cardiovascular disease is reasonable and medically necessary (FDA‑approved use).
- Echocardiography with UEAs to assess myocardial perfusion is considered reasonable and necessary when evaluating individuals with elevated cardiovascular risk factors who present with symptomatic angina and have known or suspected coronary artery disease (CAD).
- Echocardiography with UEAs to assess myocardial viability for therapeutic or diagnostic decision-making is considered reasonable and necessary.
- Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
- Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.
- Repeat or perform venous ultrasound for patients with known venous thrombosis who have a clinical change and where documented change in thrombus burden would alter management or therapy.
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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