Effective for Medicare Advantage HMO and PPO members for dates of
service on or after January 1, 2015, providers will need to obtain
precertification for outpatient echocardiography services, which include:
- stress echocardiography;
- resting transthoracic echocardiography;
- transesophageal echocardiography.
Specific CPT® codes to which the precertification applies are
listed in the table below:
Echocardiography service
CPT® code
Description
Stress echocardiography (SE)
93350
93351
Transthoracic stress echo, complete
Transthoracic stress echo, complete w/cont EKG
Resting transthoracic echocardiography (TTE)
93303
93304
93306
93307
93308
Transthoracic echo cardiac anomalies
Transthoracic echo cardiac anomalies, limited
Transthoracic echo complete w/color & spectral
Transthoracic echo complete w/o color & spectral
Transthoracic echo limited
Transesophageal echocardiography (TEE)
93312
93313
93314
93315
Transesophageal echo
Transesophageal echo probe only
Transesophageal echo interpretation
Transesophageal echo congenital
Add-on codes
93320*
93321*
93325*
93352*
Doppler echo complete
Doppler echo limited
Doppler echo flow velocity
Echo contrast agent (SE only)
*Denotes a CPT® code that is an
add-on/secondary code to the primary code and does not require review through
AIM Specialty Health® (AIM).
Precertification for outpatient echocardiography services can be obtained
through NaviNet® using the AIM ProviderPortalSM. To
do so, select AIM from the Authorizations option in the Plan
Transactions menu.
It is very important that providers use NaviNet to verify member-specific
requirements or refer to the precertification lists on our website. Failure to
obtain precertification for any of the services or drugs that require it may
result in a reduction in payment or nonpayment for the services not
authorized.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.
CPT copyright 2012 American Medical Association. All
rights reserved. CPT is a registered trademark of the American Medical
Association.