Does Q9950 require prior authorization?

No, Q9950 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for Q9950?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

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.

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.
Use of FDA‑approved ultrasound enhancing agents (UEAs) for left ventricular opacification (LVO) via IV injection when unenhanced transthoracic echocardiography cannot adequately visualize endocardial borders needed for accurate left ventricular dimensions or volumes.
Off‑label use of FDA‑approved UEAs for myocardial perfusion or myocardial viability evaluation is recognized and may be addressed for coverage by this LCD (coverage subject to LCD criteria).
Use of FDA‑approved ultrasound enhancing agents (UEAs) for left ventricular opacification (LVO) via IV injection when unenhanced transthoracic echocardiography cannot adequately visualize endocardial borders needed for accurate left ventricular dimensions or volumes.

PALMETTO-JJ-L38786, Echocardiography for Myocardial Perfusion

PALMETTO-JM-L38786, Echocardiography for Myocardial Perfusion

A58503, Billing and Coding: Echocardiography for Myocardial Perfusion

Ask Verity about documentation requirements, denial risks, or coverage in your state.