Cardiac Imaging Guidelines

This policy covers cardiac imaging services—including stress testing with and without imaging, advanced cardiac imaging for myocardial viability, and non‑imaging heart function and shunt assessments—along with related diagnostic procedures. It applies to patients with common cardiac symptoms and conditions (e.g., suspected ischemia or silent ischemia, syncope, preoperative evaluation, transplant follow‑up, hibernating myocardium, infiltrative cardiomyopathies such as Fabry, and Takotsubo), but requires a recent clinical evaluation and ECG (within 60 days), optimized medical therapy when indicated, documentation that imaging will affect management, and physician review for atypical presentations.

"High Risk (> 5%): Open peripheral vascular surgery"

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