Cardiac Imaging Guidelines

This policy covers a broad range of cardiac imaging services and modalities, including stress testing with imaging (including preoperative), transthoracic and transesophageal echocardiography (including stress echo and myocardial strain), MUGA and myocardial perfusion imaging, cardiac CT/CTA (calcium scoring, FFR‑CT), cardiac MRI, cardiac PET (perfusion/metabolic/AQMBF), and diagnostic heart catheterization. It applies to patients with common cardiac symptoms and symptom complexes and to specific populations such as preoperative patients, transplant candidates, those with heart failure, suspected cardiac amyloidosis, congenital heart disease, TAVR planning, ischemic/unstable coronary syndromes, and infection evaluations (FDG PET). Major limitations/requirements include physician review for atypical presentations, reliance on eviCore’s proprietary Clinical Review Criteria (including coding and frequency rules), and prerequisites such as a current clinical evaluation (and recent ECG for non‑advanced imaging) within 60 days before advanced imaging.