Transthoracic Echocardiography in Children - (0523)

Cigna covers initial outpatient transthoracic echocardiography (TTE) for patients under 18 only for specified cardiac indications (e.g., abnormal ECG, syncope with abnormal ECG or concerning family history, chest pain with cardiac findings, congenital heart disease, cardiotoxicity monitoring, transplant evaluation, suspected endocarditis, HCM-related and other listed systemic/structural indications) and excludes routine screening or benign presentations (e.g., isolated palpitations with a normal ECG, vasovagal syncope, innocent murmurs, PACs, sinus brady/arrhythmia, non‑exertional chest pain with a normal ECG, ADHD drug screening, and other noncovered scenarios). Claims require appropriate ICD‑10/CPT coding and supporting clinical documentation that the indication meets the policy/AUC/guideline criteria (ECG results, family history, prior tests) and myocardial strain (CPT 93356) is covered only when the primary TTE is medically necessary and one of the specified diagnoses is documented.