Local Coverage Article: Cardiovascular Stress Testing (A53123)

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1 Local Coverage Article: Cardiovascular Stress Testing (A53123) Contractor Information Contractor Name Novitas Solutions, Inc. Article Information General Information Article ID A53123 Original ICD-9 Article ID A47786 Article Title Cardiovascular Stress Testing AMA CPT / ADA CDT Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association. Original Effective Date 10/01/2015 Revision Effective Date Revision Ending Date Retirement Date

2 Article Guidance Article Text: Coding Guidelines The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. A 12 lead EKG and/or rhythm strip performed in conjunction with the stress test is not separately reimbursed. When reporting CPT code and C8928, the appropriate code from series should also be reported to capture the exercise stress portion of the study. When codes 93015, 93017, or 93350, or C8928, C8930 are used for a pharmacologic stress test, there is no separate allowance for intravenous access or infusion of pharmacologic agent. The pharmacologic agents may be billed separately. Codes and may be used in conjunction with codes 93350, 93351, C8928 or C8930. Other Comments Refer to LCD L34852 for information on Transthoracic Echocardiography (TTE). Refer to LCD L34837 for information on Transesophageal Echocardiography (TEE). Coding Information Bill Type Codes: Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims. Bill Type Codes Information Table 011x Hospital Inpatient (Including Medicare Part A) 012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient

3 083x 085x Ambulatory Surgery Center Critical Access Hospital Revenue Codes: Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. The Revenue Codes Information Table 0480 Cardiology - General Classification 0482 Cardiology - Stress Test 0483 Cardiology - Echocardiology 0636 Pharmacy - Drugs Requiring Detailed Coding CPT/HCPCS Codes Group 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. Hospitals should use guidelines and descriptors associated with the applicable Level I CPT code(s) to bill for echocardiograms without contrast. Group 1 Codes: CPT/HCPCS Codes Information Table PHARMACOLOGICAL STRESS; WITH SUPERVISION, INTERPRETATION AND REPORT PHARMACOLOGICAL STRESS; SUPERVISION ONLY, WITHOUT INTERPRETATION AND REPORT

4 PHARMACOLOGICAL STRESS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT PHARMACOLOGICAL STRESS; INTERPRETATION AND REPORT ONLY DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY) ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; INCLUDING PERFORMANCE OF CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, WITH SUPERVISION BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL USE OF ECHOCARDIOGRAPHIC CONTRAST AGENT DURING STRESS ECHOCARDIOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) UNLISTED THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INTRAVENOUS OR INTRA-ARTERIAL INJECTION OR INFUSION Group 2 Paragraph: Note: Use code above in place of code A9700 for the supply of injectable contrast material. Hospitals billing under OPPS are instructed to bill for echocardiograms with contrast or without contrast, followed by contrast studies using the applicable HCPCS code(s) below. They should also report the appropriate units of HCPCS codes for the contrast agents used in the performance of the echocardiograms.

5 Group 2 Codes: CPT/HCPCS Codes Information Table C8928 C8930 TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL- TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT TRANSTHORACIC ECHOCARDIOGRAPHY, WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL- TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT; INCLUDING PERFORMANCE OF CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, WITH PHYSICIAN SUPERVISION ICD-10 Codes that are Covered ICD-10 Codes that are Not Covered Revision History Information Associated Documents Related Local Coverage Document(s) Related National Coverage Document(s)

6 Statutory Requirements URL(s) Rules and Regulations URL(s) CMS Manual Explanations URL(s) Other URL(s) Public Version(s) Updated on 08/06/2014 with effective dates 10/01/ Keywords Read the Article Disclaimer opens in new window

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