Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

Coverage for non-emergent outpatient cardiac stress testing is governed by Local Coverage Determination L35083 and is allowed only when that LCD's reasonable and necessary clinical criteria are met. CPT 78434 (attenuation correction) must be billed only with CPT 78431 or 78492, and evaluations of LV wall motion and ejection fraction performed during SPECT MPI and attenuation correction are included in the MPI service and should not be billed separately; comprehensive, legible documentation including the ordering clinician's stated medical necessity is required.

"Coverage for non-emergent outpatient stress testing is subject to the reasonable and necessary requirements in Local Coverage Determination L35083 and is allowed only when L35083 clinical criteria ..."

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