Billing and Coding: Non-Invasive Vascular Studies

Non‑invasive vascular studies are covered when ordered by the treating or consulting practitioner with a separate documented referral/order for each study and when medical necessity is supported in the medical record. Specific surveillance schedules are defined for cerebrovascular stenosis thresholds (20–49% annual; 50–79% biannual; 80–99% biannual if not operated), post‑carotid endarterectomy (6 weeks, 6 months, 1 year), radial artery conduit mapping with conditional vein mapping, and scheduled surveillance after lower extremity bypass grafting; immediate post‑op or symptomatic evaluations are allowed irrespective of routine intervals. Claims must include appropriate diagnosis coding, referring provider NPI when required, required documentation (assessment, signed notes, test results), and comply with NCCI/OPPS and ABN/modifier rules.

"Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem."