Cardiac Imaging Guidelines

This policy covers cardiac imaging services—including stress testing with and without imaging, coronary calcium (Agatston) scoring, advanced noninvasive cardiac imaging, and cardiac functional/shunt studies—for evaluation of suspected or known coronary artery disease, angina and anginal equivalents, heart failure/hibernating myocardium, arrhythmia syndromes (e.g., ARVD/ARVC, Brugada), and transplant patients. Major limitations/requirements include a current clinical evaluation within 60 days and use of a pre-test probability grid (age/sex/symptoms) before advanced imaging, physician review for atypical presentations, exclusion if imaging will not alter management or if invasive angiography is already planned, and an adequate exercise stress load defined as rate–pressure product >25,000.

"93456 - Native coronary artery catheterization with RHC"

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