Cardiology Non-emergent Outpatient Stress Testing

Medically necessary non-emergent outpatient cardiac stress testing is covered when specific clinical indications are met: exercise ECG without imaging is appropriate for symptomatic patients with low-to-intermediate pretest probability (including certain diabetic patients) who can exercise, and stress testing with imaging is indicated for symptomatic patients who cannot exercise, have an uninterpretable ECG, prior CAD/revascularization issues, suspected ventricular dysfunction, transplant evaluation, HCM, cardiac sarcoidosis, or other specified conditions. Coverage excludes routine screening of asymptomatic patients (including most diabetics), routine repeat testing without a change in clinical status, testing within 2 years post-PCI without symptoms, pre-op testing for low-risk surgery, and applies absolute contraindications to exercise testing; documentation must show the clinical indication, prior procedures/tests and dates, inability to exercise when relevant, and provider supervision/qualifications per CMS rules.