Provider Manual

Chapter 22: Cardiology Imaging Program

This chapter describes our diagnostic imaging management program for outpatient cardiology for selected HIP members, including:

  • Prior approval procedures
  • Cardiology imaging scheduling procedures

The EmblemHealth Cardiology Imaging Program provides cardiology imaging management for outpatient cardiology imaging services. Services targeted for utilization management depend on the EmblemHealth benefit plan.

 

The Program also covers clinical standard and expedited appeals (excluding members with Medicare plans).

While most of our members’ covered cardiology imaging services are managed through this program, the following exceptions apply:

  • Members whose care is managed by Montefiore Medical Group (CMO) or HealthCare Partners (HCP) must contact the applicable organization for prior approval. Check the member’s ID card or eligibility information on emblemhealth.com to determine whether HIP, CMO, or HCP is the managing entity responsible for managing a member’s care; if HIP is the managing entity, then eviCore is the organization to contact for prior approval.
  • Members who selected a PCP affiliated with St. Barnabas Hospital or with ACPNY are excluded from this program. Effective August 20, 2018, St. Barnabas is part of the EmblemHealth Cardiology Imaging Program.
  • PCPs must enter a prior approval request at emblemhealth.com.

Services Requiring Prior Approval

Please refer to the charts later in this chapter for a list of services (and CPT-4 codes) that require prior approval. Note: All echocardiography exams require a prior approval regardless of the number of exams the member has had previously.

 

Each procedure requires a separate prior approval. Prior approvals are specific to the CPT-4 code and site location. They are valid for 45 days from the approval date.

 

Claims will be denied for procedures that require but did not receive prior approval through this program. In such cases, the member will not be liable for billing or payment.

 

Prior approval is required for services performed in the following places of service:

  • Outpatient hospital facilities
  • Freestanding radiology facilities
  • Radiology office-based settings
  • Non-radiology office-based settings

 

Prior approval is required for the following types of services:

  • Services with the CPT-4 codes later in this chapter
  • All coronary computed tomographic angiography (CCTA) services
  • Services performed in ambulatory surgery centers (cardiac catheterization procedures only)

 

Prior approval is not required for services performed in the following places of service:

  • Inpatient hospital facilities
  • Hospital emergency departments
  • Services provided when one of EmblemHealth's companies is the secondary insurer

 

Who Requests Prior Approval

We encourage PCPs or specialists to initiate the prior approval request. But requests will be accepted from the physician's office staff.

 

PCPs referring patients to a cardiologist for testing are responsible for initiating the prior approval request according to the instructions in this chapter. In cases where a cardiologist is already treating the patient, that cardiologist should initiate the request. The treating practitioner is ultimately responsible for ensuring that all applicable cardiology imaging procedures at the applicable service location have received prior approval.

 

How To Obtain Prior Approval

You may submit prior approval requests in one of three ways:

  • Online: Visit www.evicore.com. To submit online prior approval requests, the ordering physician must be a registered user. To register for a user ID and password, visit www.evicore.com and click the "Register" button.
  • By phone: Call 1-866-417-2345 for HIP, EmblemHealth CompreHealth EPO EPO (Retired August 1, 2018) , EmblemHealth Medicare HMO, GHI HMO and Vytra plan members. Call 1-800-835-7064 for EmblemHealth Medicare PPO plan members. Program representatives are available Monday through Friday, from 7 am to 7 pm. The Program is closed New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, the Friday after Thanksgiving and Christmas Day. Multiple requests may be handled with one call.
  • By fax: The fax option applies only to prior approval requests for cardiac imaging codes. You may fax these requests to 1-888-622-7369. With your fax submission, please include an EmblemHealth-specific cardiac imaging clinical request form. This form is available at www.evicore.com.

 

Please have the following information available when you call:

  • The patient's full name, member ID number and insurance information
  • The exam(s) requested for the patient
  • The working diagnosis or rule-out
  • The signs and symptoms that call for the exam, as well as their duration
  • Any previous imaging studies performed, corresponding results or pertinent lab results
  • History of prior treatment methods, drugs, surgery or other therapies, as well as duration of prior treatment
  • Any other information indicating the need for the exam

 

Expedited Approval Requests

The website cannot be used for expedited approval requests. These requests must be processed through the call center. Call 1-866-417-2345 for HIP, EmblemHealth CompreHealth EPO (Retired August 1, 2018), GHI HMO, Vytra and EmblemHealth Medicare HMO plan members. Call 1-800-835-7064 for EmblemHealth Medicare PPO plan members. Program representatives are available 24 hours a day, 7 days a week. The program is closed New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, the Friday after Thanksgiving and Christmas Day.

 

Urgent Requests

If the cardiology treatment is medically urgent and must be performed outside the Program’s  business hours, the physician may deliver treatment and must submit the prior approval request (with supporting clinical documentation) within two business days. Urgent requests are reviewed against medical necessity criteria, and an approval is issued as long as the request meets these medical necessity criteria. Urgent requests will be completed within 24 hours of receiving the request.

The website cannot be used for urgent approval requests. These requests must be processed through the call center. Call 1-866-417-2345 for HIP, EmblemHealth CompreHealth EPO (Retired August 1, 2018), GHI HMO, Vytra and EmblemHealth Medicare HMO plan members. Call 1-800-835-7064 for EmblemHealth Medicare PPO plan members. Program representatives are available 24 hours a day, 7 days a week. The program is closed New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, the Friday after Thanksgiving and Christmas Day.

 

Non-Urgent Requests

Non-urgent requests will be completed within three business days of receiving all necessary information, or within the time frames otherwise required by the member's benefit plan (see Standard Pre-Service Review in the Care Management chapter). In most cases, we will review and determine prior approvals during the initial phone call, as long as all the required information is provided. The review and determination processes may, however, take longer if member or practitioner eligibility verification is required, or if the request requires additional clinical review (see Standard Pre-Service Review in the Care Management chapter).

 

A physician with office hours later than the Program's call center may initiate a case through the Program’s website. We will process the request on the next business day.

 

Modifying a Prior Approval Request

If it becomes necessary to change or update the procedure after prior approval is obtained, we must be contacted no later than 48 hours after the modified procedure is performed. If the prior approval for the treatment plan is not updated and the claim does not match the authorized procedures, the claim will be denied for payment, with no liability to the member.

 

Verifying the Prior Approval Status

To verify the status of a prior approval request, either call the numbers that follow or visit the Authorization Lookup section of the website at www.evicore.com. Call 1-866-417-2345 for HIP, EmblemHealth CompreHealth EPO (Retired August 1, 2018), GHI HMO, Vytra and EmblemHealth Medicare HMO plan members. Call 1-800-835-7064 for EmblemHealth Medicare PPO plan members.

 

Note: While we may approve or deny a prior approval request, this determination is based on medical necessity only. Always verify member eligibility, benefits and copayments directly with EmblemHealth at www.emblemhealth.com.

 

Determination Disagreement

If a physician disagrees with the determination, contact the Program’s Peer-to-Peer Consultation Line to discuss the case with a medical director. Call 1-866-417-2345 for HIP, EmblemHealth CompreHealth EPO (Retired August 1, 2018), GHI HMO, Vytra and EmblemHealth Medicare HMO plans. Call 1-800-835-7064 for EmblemHealth Medicare PPO plan members.

 

CPT-4 Codes Requiring Prior Approval

The following CPT-4 codes require prior approval for all plans covered by the EmblemHealth Cardiology Imaging Program:

Cardiology Imaging Prior Approval Code List For EmblemHealth CompreHealth EPO (Retired August 1, 2018), EmblemHealth Medicare HMO/PPO, GHI HMO and HIP Benefit Plans Effective October 1, 2012 (Vytra EFFECTIVE JANUARY 1, 2016)
Cardiology Imaging CPT Code Procedure Description

75557

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL

75559

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL; WITH STRESS IMAGING

75561

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES

75563

CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; WITH STRESS IMAGING

75571*

COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, WITH QUANTITIVE EVALUATION OF CORONARY CALCIUM

75572

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

75573

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING,ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

75574

COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)

78451

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC)

78452

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION

78453

MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC)

78454

MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION

78459

MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVALUATION

78491

MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY AT REST OR STRESS

78492

MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST AND/OR STRESS

93303

TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE

93304

TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY

93306

ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY

93307

ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY

93308

ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY

93350

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

93351

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.

93452

LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION, WHEN PERFORMED

93453

COMBINED RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION, WHEN PERFORMED

93454

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION

93455

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL VENOUS GRAFTS) INCLUDING INTRAPROCEDURAL INJECTION(S) FOR BYPASS GRAFT ANGIOGRAPHY

93456

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT HEART CATHETERIZATION

93457

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS), INCLUDING INTRAPROCEDURAL INJECTION(S) FOR BYPASS GRAFT ANGIOGRAPHY AND RIGHT HEART CATHETERIZATION

93458

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED

93459

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH LEFT HEART CATHETERIZATION, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED, CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS) WITH BYPASS GRAFT ANGIOGRAPHY

93460

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED

93461

CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT AND LEFT HEART CATHETERIZATION, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED, CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS) WITH BYPASS GRAFT ANGIOGRAPHY

93462

LEFT HEART CATHETERIZATION BY TRANSSEPTAL PUNCTURE THROUGH INTACT SEPTUM OR BY TRANSAPICAL PUNCTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

C8921

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE

C8922

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY

C8923

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITHOUT SPECTRAL OR COLOR DOPPLER ECHOCARDIOGRAPHY

C8924

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, FOLLOW-UP OR LIMITED STUDY

C8928

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

C8929

TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, OR WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN PERFORMED, COMPLETE, WITH SPECTRAL DOPPLER ECHOCARDIOGRAPHY, AND WITH COLOR FLOW DOPPLER ECHOCARDIOGRAPHY

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; INCLUDING PERFORMANCE OF CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, WITH PHYSICIAN SUPERVISION

*GHI HMO exception: 75571 is not a GHI HMO contracted code.

The following codes may no longer be billed. Please reference these codes for older claims (claims for dates of service prior to 1/1/2011).

Cardiology Imaging Procedures Requiring Prior Approval 
CPT-4 Code List

Effective 1/1/2011 to 12/31/11
For Reference Only - Do Not Use

CPT-4
Code

Procedure Description

75557

Cardiac magnetic resonance imaging (MRI) for morphology and function without contrast material

75559

Cardiac MRI for morphology and function without contrast material; with stress imaging

75561

Cardiac MRI for morphology and function without contrast material(s), followed by contrast material(s) and further sequences

75563

Cardiac MRI for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging

75571

Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium

75572

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology

75573

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease

75574

Computed tomographic angiography, heart, coronary arteries and bypass grafts, with contrast material, including 3D image postprocessing

78451

Myocardial perfusion imaging, tomographic (SPECT), single study, at rest or stress

78452

Myocardial perfusion imaging, tomographic (SPECT), multiple studies, at rest and/or stress and/or redistribution and/or rest reinjection

78453

Myocardial perfusion imaging, planar, single study, at rest or stress

78454

Myocardial perfusion imaging, planar, multiple studies, at rest or stress and/or redistribution and/or rest reinjection

78456

Acute venous thrombosis imaging, peptide

78457

Venous thrombosis imaging, venogram, unilateral

78458

Venous thrombosis imaging, venogram, bilateral

78459

Myocardial imaging, positron emission tomography (PET), metabolic evaluation

93303

Transthoracic echocardiography for congenital cardiac anomalies, complete

93304

Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited study

93306

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

93307

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography

93308

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study

93350

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test

93351

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress, including performance of continuous electrocardiographic monitoring, with physician supervision

93451

Right heart catheterization, including measurement(s) of oxygen saturation and cardiac output, when performed

93452

Left heart catheterization, including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed

93453

Combined right and left heart catheterization, including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed

93454
(replaces 93508)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation

93455
(replaces 93508)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts), including intraprocedural injection(s) for bypass graft angiography

93456

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization

93457

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts), including intraprocedural injection(s) for bypass graft angiography and right heart catheterization

93458
(replaces 93510)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization, including intraprocedural injection(s) for left ventriculography, when performed

93459 (replaces 93510)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization, including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

93460
(replaces 93526)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with right and left heart catheterization, including intraprocedural injection(s) for left ventriculography, when performed

93461
(replaces 93526)

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization, including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

93462
(replaces 93524)

Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for primary procedure)

 

Formal Dispute Resolution

Please submit to EmblemHealth:

  • Appeals for Medicare members. Please follow EmblemHealth's standard processes for Medicare members, described in the Dispute Resolution for Medicare Plans chapter.
  • Complaints and grievances. Please refer to the Dispute Resolution chapters for Commercial/CHP and Medicaid, as applicable.

 

Please submit to the Program:

  • Expedited and standard clinical appeals for Commercial/CHP members and expedited and standard action appeals for Medicaid members. Appeals may be filed by the member, the member's delegate (including the practitioner acting as the member's delegate) or by practitioners on their own behalf. For a full description of member and practitioner rights regarding clinical and action appeals, see the Dispute Resolution chapters for Commercial/CHP and Medicaid, as applicable.