Cardiology Non-emergent Outpatient Stress Testing

Outpatient cardiovascular stress testing (with or without imaging) is covered when specific clinical indications are met—examples include symptomatic patients with appropriate pre-test probability, patients unable to exercise or with uninterpretable ECGs, recent ACS without angiography, selected pre-operative evaluations, transplant evaluation, and targeted uses such as viability assessment or suspected cardiac sarcoidosis. Routine screening of asymptomatic patients, early post-PCI testing within 2 years, routine repetitive monitoring without change in clinical status, testing that will not affect management, and testing when invasive angiography is already planned are not covered; absolute contraindications to exercise testing apply. Documentation must support medical necessity (symptoms, prior procedures and dates, ECG status, inability to exercise, and that results will affect management), and testing must be supervised by appropriately trained personnel per CMS requirements.