SUBJECT: NONINVASIVE VASCULAR STUDIES

POLICY NUMBER:

DESCRIPTION:

The accuracy of diagnostic ultrasound and echocardiography procedures depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit. (See Documentation Requirements section of this policy for certificate/accreditation requirements.)

Vascular studies include patient care required to perform the studies, supervision of the studies and interpretation of study results with copies for patient records of hard copy output or imaging when provided. The use of a simple hand-held or other Doppler device that does not produce hard copy output, or that does not permit analysis of bidirectional vascular flow, is considered part of the physical examination of the vascular system and is not separately reimbursable.¹ Doppler procedures performed with zero-crossers (i.e., analog [strip chart recorder] analysis) are also included in this office visit as well.

The accuracy of noninvasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit. Furthermore, effective January 1, 1997, all noninvasive vascular diagnostic studies must be either (1) performed by, or under the direct supervision of, persons that have demonstrated minimum entry level competency by being credentialed in vascular technology, or (2) performed in facilities with laboratories accredited in vascular technology. Examples of appropriate personnel certification include the Registered Vascular Technologist (RVT) credential and the Registered Cardiovascular Technologist (RCVT) credential in Vascular Technology, and appropriate laboratory accreditation includes the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) or the Ultrasound Practice Accreditation Commission of the American Institute of Ultrasound in Medicine. Direct supervision requires the credentialed individuals physical presence in the facility during the examination.

Thermography, mechanical oscillometry, inductance plethysmography, capacitance plethysmography, and photoelectric plethysmography are not covered services. Light reflection rheography is not a covered service based on lack of documentation of medical necessity in the current literature.

It is the responsibility of the provider to ensure the medical necessity of procedures and to maintain a record for post-payment audit. Noninvasive vascular studies are medically necessary only if the outcome will potentially impact the clinical course of the patient. For example, if a patient is (or is not) going to proceed on to other diagnostic and/or therapeutic procedures regardless of the outcome of noninvasive studies, noninvasive vascular procedures are not medically necessary. That is, if it is obvious from the findings of the history and physical examination that the patient is going to proceed to angiography, then noninvasive vascular studies are not medically necessary.

A duplex scan includes a real-time scan (see CPT-4; Diagnostic Ultrasound). Consequently billing for both a duplex scan and echography of the same body part represents unbundling and is not allowed.

As published in the Federal Register on November 22, 1996, diagnostic tests, to be covered, must be ordered by the practitioner that treats the patient. The treating physician is the practitioner responsible for the treatment of the patient and who orders the test to use the results in the management of the beneficiary's specific medical problem(s). Consulting physicians may also order tests.

DEFINITIONS

Duplex scan: Implies an ultrasonic scanning procedure with display of both two-dimensional structure and motion with time and Doppler ultrasonic signal documentation with spectrum analysis and/or color flow velocity mapping or imaging.

Physiologic studies: Implies functional measurement procedures including Doppler ultrasound studies, blood pressure measurements, transcutaneous oxygen tension measurements, or plethysmography.

Plethysmography: Implies volume measurement procedures including air, impedance, or strain gauge methods.

POLICY TYPE: Local Medical Review Policy

HCPCS SECTION

& BENEFIT CATEGORY: Radiology; Diagnostic Ultrasound

Medicine; Non-Invasive Vascular Diagnostic Studies

HCPCS CODES©:

76936 - Ultrasound guided compression repair of arterial pseudo-aneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging)
93875 - Non-invasive physiological studies of extracranial arteries, complete bilateral study (eg, periorbital flow direction with arterial compression, ocular pneumoplethysomography, Doppler ultrasound spectral analysis)
93880 - Duplex scan of extracranial arteries; complete bilateral study
93882 - unilateral or limited study
93886 - Transcranial Doppler study of the intracranial arteries; complete study
93888 - limited study
93922 - Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (eg, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)
93923 - Non-invasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (eg, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia)
93924 - Non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study
93925 - Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
93926 - unilateral or limited study
93930 - Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study
93931 - unilateral or limited study
93965 - Non-invasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)
93970 - Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study
93971 - unilateral or limited study
93975 - Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study (Refer to IMPOTENCE policy for coverage.)
93976 - limited study (Refer to IMPOTENCE policy for coverage.)
93978 - Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study (Refer to IMPOTENCE policy for coverage)
93979 - unilateral or limited study (Refer to IMPOTENCE policy for coverage.)
93980 - Duplex scan of arterial inflow and venous outflow of penile vessels; complete study (Refer to IMPOTENCE policy for coverage.)
93981 - follow-up or limited study (Refer to IMPOTENCE policy for coverage.)
93990 - Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow

HCFA's NATIONAL POLICY:

- Title XVIII of the Social Security Act, section 1862(a)(7). This section excludes routine physical examinations.

- Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.

- Medicare Carrier Manual, Appendix, Coverage Issues - Diagnostic Services, Coverage Issues 50-6

- Federal Register, Volume 57, Number 25, Friday, November 20, 1992

INDICATIONS AND LIMITATIONS:

I. CEREBROVASCULAR EXAMINATION

(CPT Codes 93875 through 93888)

Indications For Cerebrovascular Evaluations:

1. Cervical bruits.

2. Amaurosis fugax.

3. Focal cerebral or ocular transient ischemic attacks (i.e., localizing symptoms, weakness of one side of the face, slurred speech, weakness of a limb). Visual transient ischemic attacks are defined as retinal or hemispheric visual field deficits and not temporary blurred vision.

4. Drop attacks or syncope are rare indications primarily seen with vertebrobasilar or bilateral carotid artery disease. Incoordination or limb dysfunction should be grouped with unilateral weakness of the face or extremities.

Examples Of Signs And Symptoms That Do Not Demonstrate Medical Necessity

1. Dizziness is not a typical indication unless associated with other localizing signs or symptoms. However, episodic dizziness with symptom characteristics typical of transient ischemic attacks may indicate medical necessity, especially when other more common sources (e.g., postural hypotension or transiently decreased cardiac output as demonstrated by cardiac events monitoring) have been previously excluded.

2. Headaches are not an indication for extracranial studies.

TRANSCRANIAL DOPPLER (TCD) (93886 or 93888)

The accuracy of TCD examinations depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the providers of TCD studies must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit. An example of acceptable training and experience would be a physician and/or registered vascular technologist with documentation of attendance at a formal TCD training program that includes hands on experience and results in a certificate of proficiency, and with a minimum experience of 100 patient TCD examinations.

TCD is an allowed procedure and is of established value in:

1. Detection and evaluation of the hemodynamic effects of severe stenosis or occlusion of the extracranial (greater than or equal to 60% diameter reduction) and major basal intracranial arteries (greater than or equal to 50% diameter reduction).
2. Detection and serial evaluation of cerebral vasospasm complicating subarachnoid hemorrhage.
3. Evaluation of invasive therapeutic interventions for cerebral arteriovenous malformations.
4. Evaluation of intracranial hemodynamic abnormalities in patients with suspected brain death.
5. Intraoperative and perioperative monitoring of intracranial flow velocity and hemodynamic patterns during carotid endarterectomy. This is primarily a Medicare Part A procedure but the professional component could be reimbursed given it is provided during the operative procedure by a physician that is not a member of the operating team.
6. Evaluation of cerebral embolization.

Examples of non-acceptable indications include:

1. Evaluation of brain tumors.
2. Assessment of familial and degenerative diseases of the cerebrum, brainstem, cerebellum, basal ganglia and motor neurons.
3. Evaluation of infectious and inflammatory conditions.
4. Psychiatric disorders.
5. Epilepsy.

II. PERIPHERAL ARTERIAL EXAMINATIONS

(CPT Codes 93920 - 93931)

Noninvasive peripheral arterial examinations, performed to establish the level and/or degree of arterial occlusive disease, are medically necessary if (1) significant signs and/or symptoms of possible limb ischemia are present and (2) the patient is a candidate for invasive therapeutic procedures. A routine history and physical examination, which includes Ankle/Brachial Indices (ABIs), can readily document the presence or absence of ischemic disease in a majority of cases. It is not medically necessary to proceed beyond the physical examination for minor signs and symptoms such as hair loss, absence of a single pulse, relative coolness of a foot, shiny thin skin, or lack of toe nail growth unless related signs and/or symptoms are present which are severe enough to require possible invasive intervention.

An ABI (1) is not a reimbursable procedure in itself, and (2) should be abnormal (i.e., < 0.9 at rest) and must be accompanied by another appropriate indication before proceeding to more sophisticated or complete studies, except in patients with severe diabetes resulting in medial calcification as demonstrated by artifactually elevated ankle blood pressures.

Peripheral Arterial Examinations

A. Indications For Peripheral Arterial Evaluations

1. Claudication of less than one block or of such severity that it interferes significantly with the patient's occupation or lifestyle.

2. Rest pain (typically including the forefoot), usually associated with absent pulses, which becomes increasingly severe with elevation and diminishes with placement of the leg in a dependent position.

3. Tissue loss defined as gangrene or pregangreneous changes of the extremity, or ischemic ulceration of the extremity occurring in the absence of pulses.

4. Aneurysmal disease.

5. Evidence of thromboembolic events.

6. Blunt or penetrating trauma (including complications of diagnostic and/or therapeutic procedures).

7. For evaluation of dialysis access, see policy regarding CPT code 93990.

B. Examples Of Signs And Symptoms That Do Not Indicate Medical Necessity

1. Continuous burning of the feet is considered to be a neurologic symptom.

2. "Leg pain, nonspecific" and "Pain in limb" as single diagnoses are too general to warrant further investigation unless they can be related to other signs and symptoms.

3. Edema rarely occurs with arterial occlusive disease unless it is in the immediate postoperative period, in association with another inflammatory process or in association with rest pain.

4. Absence of relatively minor pulses (i.e., dorsalis pedis or posterior tibial) in the absence of symptoms. The absence of pulses is not an indication to proceed beyond the physical examination unless it is related to other signs and/or symptoms.

III. PERIPHERAL VENOUS EXAMINATIONS

(CPT Codes 93965-93971)

Indications for venous examinations are separated into two major categories: deep vein thrombosis and chronic venous insufficiency. Studies are medically necessary only if the patient is a candidate for anticoagulation, thrombolysis or invasive therapeutic procedures.

Since the signs and symptoms of arterial occlusive disease and venous disease are so divergent, the performance of simultaneous arterial and venous studies during the same encounter should be rare. Consequently, a document clearly supporting the medical necessity of both procedures performed during the same encounter must be available for post-payment audit.

A. DEEP VEIN THROMBOSIS (DVT):

DVT is the most common vascular disorder that develops in hospitalized patients and can develop after trauma or prolonged immobility (sitting or bedrest). Unfortunately, the signs and/or symptoms of DVT are relatively non-specific and, due to the risk associated with pulmonary embolism (PE), objective testing is allowed in patients that are candidates for anticoagulation or invasive therapeutic procedures for the following indications:

1. Clinical signs and/or symptoms of DVT including edema, tenderness, inflammation, and/or erythema.
2. Clinical signs and/or symptoms of PE including hemoptysis, chest pain, and/or dyspnea.
3. Unexplained lower extremity edema status-post major surgical procedures.

Bilateral limb edema in the presence of signs and/or symptoms of congestive heart failure, exogenous obesity and/or arthritis should rarely be an indication.

B. CHRONIC VENOUS INSUFFICIENCY:

Chronic venous insufficiency may be divided into three categories: primary varicose veins, secondary varicose veins and post-thrombotic (post-phlebitic) syndrome. It is not medically necessary to study primary varicose veins. Objective tests of venous function may be indicated in patients with ulceration suspected to be secondary to venous insufficiency in order to confirm this diagnosis by documenting venous valvular incompetence prior to treatment.

Performance of both duplex scanning (93970 or 93971) and physiological tests (93965) of extremity veins during the same encounter is not medically necessary.

IV. HEMODIALYSIS ACCESS EXAMINATION

(CPT Code 93990)

Limited coverage has been established for duplex scanning of hemodialysis access sites in patients with end stage renal disease (ESRD). These procedures are medically necessary only in the presence of signs or symptoms of impending failure of the access site and when the results may impact the clinical course of the patient. Evaluation of failed access sites are not medically necessary.  Furthermore, when services are provided by the ESRD physician of record, services are considered renal related and are, therefore, part of the physicians monthly capitated fee and are not separately reportable. Services performed by a Medicare approved ESRD facility are covered services under the composite rate of the facility and therefore not separately reimbursable.

Appropriate indications for Duplex scan of hemodialysis access sites include:

ICD-9-CM code 996.73: Complication (Complication NOS, occlusion NOS, embolism, fibrosis, hemorrhage, pain, stenosis, thrombosis) due to renal dialysis device, implant, and graft; as demonstrated by clear documentation in the dialysis record of signs of chronic (i.e., 3 successive dialysis sessions) of abnormal function including:

1) elevated venous pressure greater than 200 mmHg on a 300 cc/min pump, or
2) elevated recirculation time of 15% or greater at a flow rate of 250 to 300 cc/min.

Routine evaluation on a daily or weekly basis without evidence of the above is considered screening and is not a covered service.

V. ULTRASOUND GUIDED REPAIR OF PSEUDOANEURYSM

(CPT Code 76936)

Diagnosis of pseudoaneurysm is primarily based on history and physical examination. Consequently, CPT code 76936 includes CPT codes 93926 through 93931 and these procedures are not separately reimbursable. The medical necessity of ultrasound guided repair of arteriovenous fistulae is not supported by a review of the current literature and is, therefore, not reimbursable.

Acceptable indications include a pulsatile mass indicating a pseudoaneurysm and the patient must be at least three (3) days status-post invasive vascular procedure. When performed in conjunction with the invasive procedure, 76936 is considered part of the invasive procedure and is not separately reportable.

ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY:

Cerebrovascular evaluation (93875-93888)

- 342.0-342.92, 344.0-344.09. 344.1, 344.2, 344.3-344.32, 344.4-344.42, 344.5, 344.9, 362.3-362.37, 362.84, 368.10, 368.11, 368.12, 368.4-368.47, 433.0-433.91, 434.0-434.91, 435.0-435.9, 436, 437.0, 437.3, 437.4, 437.7, 442.81, 442.82, 446.0-446.7, 780.2, 780.4, 781.2, 781.3, 781.4, 782.0, 784.3, 784.5, 785.9, 900.0-900.9, 901.1, 996.1, 996.7-996.79, 997.0-997.99 (11/15/1996), 998.0-998.9

Extremity Arterial Evaluation (93920-93931)

- 440.0, 440.21, 440.22, 440.23, 440.24, 440.30, 440.31, 440.32, 441.0-441.9, 442.0, 442.3, 443.0-443.9, 444.0-444.9, 447.0, 447.1, 447.2, 707.1, 707.8, 785.4, 903.0-903.9, 904.0-904.9, 996.1, 996.7-996.79, 997.2 (11/15/1996), 998.1, 998.2

Extremity Venous Evaluation (93965-93971)

- 415.1-415.19, 451.0-451.8, 454.0, 454.2, 459.1, 459.2, 671.2-671.24, 671.3-671.33, 671.4-671.44, 695.9, 707.1, 729.5, 729.81, 747.6-747.69, 782.2, 782.3, 785.4, 786.00, 786.01, 786.02, 786.09, 786.3, 786.52, 786.59, 794.2, 903.0-903.9, 904.0-904.9, 996.1, 996.7-996.79, 997.2, 998.2, 999.2, V12.51 (11/15/1996), V12.52 (11/15/1996)

Hemodialysis access Examination (93990)

- 996.73

REASONS FOR DENIAL:

The following applications are in the research phase and are considered investigational:

1. Assessing patients with migraine.
2. Monitoring during carotid endarterectomy, cardiopulmonary bypass and other cerebrovascular and cardiovascular interventions, and surgical procedures (except during carotid endarterectomy, as noted above).
3. Evaluation of patients with dilated vasculopathies such as fusiform aneurysms.
4. Assessing autoregulation, physiologic, and pharmacological responses of cerebral arteries.

NONCOVERED ICD-9 CODES: All ICD-9 CM codes not listed as covered in this policy.

SOURCES OF INFORMATION:

1. Non-invasive Vascular Diagnostic Studies, in Physicians' Current Procedural Terminology 1995, American Medical Association, pps. 543-544, 1995.
2. Strandness DE, Andros G, Baker JD, Bernstein EF. Vascular laboratory utilization and payment: Report of the Ad Hoc Committee of the Western Vascular Society. J Vasc Surg 1992; 16:163-169.
3. Assessment: Transcranial Doppler. Report of the American Academy of Neurology, Therapeutics and Technology Assessment Subcommittee. Neurology 1990; 40:680-681.
4. ICAVL Essentials and Standards for Accreditation in Noninvasive Vascular Testing; Part II, Vascular Laboratory Operations, Cerebrovascular Testing, 1995.
5. Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA 1995; 273: 1421 - 1428.
6. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ, Kargman DE, Sacco RL, Wityk RJ, Ford G, Fayad PB. The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology 1995; 45:1488-1493.
7. ICAVL Essentials and Standards for Accreditation in Noninvasive Vascular Testing; Part II, Vascular Laboratory Operations, Peripheral Arterial Testing, 1995.
8. ICAVL Essentials and Standards for Accreditation in Noninvasive Vascular Testing; Part II, Vascular Laboratory Operations, Peripheral Venous Testing, 1995.

CODING GUIDELINES:

Cerebrovascular Examination
A. Acceptable Procedures for Reimbursement
(CPT Codes 93875 - 93888)

1. Duplex scan (93880 or 93882).
2. Doppler ultrasound with spectrum analysis (93875).
3. Oculopneumoplethysmogaphy (OPPG) (93875).
4. Periorbital Doppler (93875) when OPPG is contraindicated.
5. Transcranial Doppler (TCD) (see below) (93886 or 93888).

Multiple cerebrovascular procedures can be allowed during the same encounter given the provider can demonstrate medical necessity on post-payment audit. That is, physiologic studies and a duplex scan are allowed on the same date of service given the provider is able to document medical necessity (e.g., greater than or equal to 50% stenosis on duplex scan or significant symptoms as demonstrated by the indications for the study) on post-payment audit.

B. Methods Not Acceptable For Reimbursement:

(CPT Codes 93875-93888)

1. Pulse delay oculoplethysmography.
2. Carotid phonoangiography and other forms of bruit analysis are covered services but are included in the reimbursement for the office visit.
3. Periorbital photoplethysmography.

C. Recommendations For Follow-up Studies:

(CPT Codes 93875-93888)

1. Stenosis of 20-50% (diameter reduction), an annual study.
2. Stenosis of 50-79%, every six months.
3. Stenosis of 80-99%, surgery is usually recommended.
4. After carotid endarterectomy, repeat examinations are allowed at six weeks, six months, and one year. During the first year, follow-up studies should be unilateral unless signs and symptoms provide indications for a bilateral procedure.

PERIPHERAL ARTERIAL EXAMINATIONS

(CPT Codes 93920-93931)

A. Acceptable Procedures For Reimbursement

1. Duplex scan (93925, 93926, 93930, or 93931).
2. Single level physiologic studies (e.g., Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement) (93922).
3. Segmental physiologic studies or with provocative functional maneuvers (93923).
4. Physiologic studies at rest and following treadmill stress testing (93924).

A complete extremity physiologic study includes pressure measurements and an additional physiologic technique (e.g., Doppler ultrasound study or plethysmography).

Transcutaneous oxygen tension measurements are acceptable to evaluate healing potential in nonhealing or difficult to heal wounds at a frequency of no greater than twice in any 60 day period.

Duplex scanning and physiologic studies may be reimbursed during the same encounter if the physiologic studies are abnormal and/or to evaluate vascular trauma, thromboembolic events or aneurysmal disease, given the provider can document medical necessity.

B. Methods Not Acceptable For Reimbursement

(CPT Codes 93920-93931)

1. Mechanical Oscillometry.
2. Inductance Plethysmography.
3. Capacitance Plethysmography.
4. Photoelectric Plethysmography.
5. ABI (considered part of the physical examination).

C. Post-intervention Follow-up Studies:

(CPT Codes 93920-93931)

Duplex post-interventional follow-up studies are typically limited in scope and unilateral in nature. Consequently, the "complete" duplex scan codes (i.e., 93925 or 93930) should seldom be used while the "unilateral or limited study" codes (i.e., 93926 or 93931) should typically be used.

1. In the immediate post-operative period, patients may be studied if re-established pulses are lost, become equivocal, or if the patient develops related signs and/or symptoms of ischemia with impending repeat intervention.

2. With regard to autogenous lower extremity vein bypass surgeries, a study can be performed at three month intervals during the first year, at six month intervals during the second year, and annually thereafter. Follow-up studies are not medically necessary post-angioplasty in the absence of signs and/or symptoms of ischemia. Synthetic grafts may be studied if the patient develops signs and/or symptoms of occlusive disease.

In general, noninvasive studies of the arterial system are to be utilized when invasive correction is contemplated, but not to follow noninvasive medical treatment regimens. The latter may be followed with physical findings and/or progression or relief of signs and/or symptoms. Screening of the asymptomatic patient is not covered by Medicare.

PERIPHERAL VENOUS EXAMINATIONS

(CPT Codes 93965-93971)

A. Acceptable Procedures for Reimbursement:

1. Duplex scan (93970 or 93971).
2. Doppler waveform analysis including responses to compressions and other maneuvers (93965).
3. Impedance Plethysmography (93965).
4. Air Plethysmography (93965).
5. Strain Guage Plethysmography (93965).

B. Methods Not Acceptable For Reimbursement:

1. Mechanical Oscillometry.
2. Inductance Plethysmography.
3. Capacitance Plethysmography.
4. Photoelectric Plethysmography.

Performance of both duplex scanning (93970 or 93971) and physiological tests (93965) of extremity veins during the same encounter is not medically necessary.

C. Follow-up Studies

Frequency of follow-up studies will be carefully monitored for medical necessity and it is the responsibility of the provider to maintain documentation of medical necessity for post-payment audit.

DOCUMENTATION REQUIREMENTS:

Diagnostic Ultrasound & Echocardiography
Certification and Accreditation
CPT Codes 76506 - 76999 & 93303 - 93350

Effective January 1, 1997, all procedures must be either (1) performed by, or under the direct supervision of, persons that have demonstrated minimum entry level competency by being credentialed in the specific type of procedure being performed, or (2) performed in laboratories accredited in the specific type of evaluation. Direct supervision requires the credentialed individuals physical presence in the facility during the examination.

Examples of appropriate personnel certification include the Registered Diagnostic Medical Sonographer (RDMS) credential, the Registered Diagnostic Cardiac Sonographer (RDCS) credential, the Registered Cardiovascular Technologist (RCVT) credential, or the Certified Ophthalmic Medical Technologist (COMT) credential. Each credential must include the specialty area for the examination being performed. Some examples of appropriate specialty areas for specific Current Procedural Terminology (CPT) codes are listed below.

Appropriate laboratory accreditation includes the Ultrasound Practice Accreditation Commission (UPAC) of the American Institute of Ultrasound in Medicine and the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Each accreditation must include the specialty area for the examination being performed.

OTHER COMMENTS: Medicare Providers' News LAB98-05, LA96-05, LA96-02, LA95-07, LA95-05, LA95-04, and LA93-03

CAC NOTES:

This policy does not reflect the sole opinion of the carrier or Carrier Medical Director. Although the final decision rests with the carrier, this policy was developed in cooperation with the Carrier Advisory Committee (03/1995), which includes representatives from all recognized specialties with the state.

START DATE OF COMMENT PERIOD: 02/24/1995

START DATE OF NOTICE PERIOD:
11/1998
11/15/1996
06/01/1995

EFFECTIVE DATE: 07/01/1995

REVISION DATE:

REVISION NUMBER:

This page was last updated on 09/09/03 .