CG-MED-57 Cardiac Stress Testing with Electrocardiogram

This policy addresses cardiac stress testing with electrocardiogram (ECG) (CPT 93015–93018). It is medically necessary for coronary evaluation to diagnose obstructive coronary artery disease (CAD) in adults with intermediate pretest probability based on age/sex/symptoms or with vasospastic angina, and for risk assessment/prognosis in symptomatic individuals or those with prior CAD (including initial evaluation of suspected/known CAD or when there is a significant change in clinical status after prior stress testing). It is not medically necessary when criteria are not met, including screening of asymptomatic individuals with low pretest probability of disease.

"Cardiac stress testing with electrocardiogram is consideredmedically necessaryas part of a coronary evaluation forANYof the following indications (A through G):"

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