Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography

Covered when signs/symptoms of CAD or related conditions exist or when testing may change management (e.g., post‑MI or revascularization, arrhythmia, syncope, heart failure, significant vascular disease, diabetes, abnormal ECG), for intermediate/high‑risk preoperative evaluation, or when an electrical stress test is inadequate (including indications for stress echo and RNI); excluded for asymptomatic screening, routine annual testing without individualized indications, testing to qualify for noncovered services or solely to motivate lifestyle change, simultaneous stress echo with myocardial perfusion imaging or radionuclide ventriculography, or when results would not affect treatment. Medical necessity and frequency must be documented (reference appropriate use criteria such as ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 for RNI), plus the referral order, reason for modality and pharmacologic stress (if used), complete interpretation, physician supervision documentation, and leasing contracts when applicable; Medicare denies tests without adequate documentation or for preop evaluation of noncovered surgeries.