Does Q9956 require prior authorization?

No, Q9956 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for Q9956?

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

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.

CGS-L34338, Transthoracic Echocardiography (TTE)

J15

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NOVITAS-L35016, Transesophageal Echocardiography (TEE)

PALMETTO-JJ-L38786, Echocardiography for Myocardial Perfusion

NGS-L33577

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