CPT CODE 93875, 93880, 93882 - Non-Invasive Cerebrovascular Studies

CPT code and description

93880 - Duplex scan of extracranial arteries; complete bilateral study -average fee amount -$200 -$210

93875 - Noninvasive physiologic studies of extracranial arteries, complete bilateral study (eg, periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis)


93882 - Duplex scan of extracranial arteries; unilateral or limited study

93886 - Transcranial Doppler study of the intracranial arteries; complete study

93888 - Transcranial Doppler study of the intracranial arteries; limited study

93890 - Transcranial Doppler study of the intracranial arteries; vasoreactivity study

93892 - Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection


93893 - Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection

Indications for procedure codes 93875 (physiologic studies), 93880 and 93882 (duplex scanning) are:

  • Amaurosis fugax.
  • Cervical bruits.
  • Pulsatile neck masses.
  • Follow-up of patients with proven carotid disease who are receiving medical therapy.
  • Follow-up for postoperative patients following carotid endarterectomy.
  • Hemispheric neurologic symptoms of stroke.
  • Blunt neck trauma.
  • Subclavian steal syndrome.
  • Focal cerebral or ocular transient ischemic attacks (i.e., localizing symptoms, weakness of one side of the face, slurred speech, weakness of a limb, ocular ischemia).
  • Preoperative evaluation of selected patients scheduled for major cardiovascular surgical procedures that, because of their clinical history and/or presentation, are at increased risk of intraoperative or perioperative stroke (dual-diagnosis required; see below).
  • Evaluation of suspected dissection.


The following are qualifications to the indications listed above for procedure codes 93875, 93880 and 93882:
  • Ocular transient ischemic attacks are defined as retinal or visual field deficits and not temporarily blurred vision.
  • Episodic dizziness with symptoms typical of transient ischemic attacks may indicate reasonableness and necessity, especially when other more common sources, (e.g., postural hypotension or transiently decreased cardiac output, as demonstrated by cardiac event monitoring) have been previously excluded. Dizziness and giddiness alone are not usual indications for duplex ultrasonography of the extracranial arteries unless associated with other localizing symptoms. Although episodic dizziness/vertigo may be a symptom of Transient Ischemic Attack (TIA), the medical record should document that more common causes of dizziness/vertigo, (e.g., postural hypotension, arrhythmia, decreased cardiac output) were ruled out prior to evaluation with duplex ultrasonography. Report duplex ultrasonography of the extracranial arteries performed in clinical circumstances consistent with cerebral ischemia and when there is a strong clinical suspicion of TIA using appropriate TIA diagnosis codes.
  • Headaches, other than basilar, hemiplegic and classical with intractable migraine are not indications for extracranial arterial studies.
  • Since “drop attacks” or syncope are seen with vertebrobasilar or bilateral carotid artery disease, documentation in the medical record must substantiate the suspected existence of these diseases when using these codes.

Transcranial Doppler (TCD) studies (93886, 93888, 93890, 93892 and 93893) are indicated for the following:

  • Detection of severe stenosis (>65 percent) in the major basal intracranial arteries.
  • Assessment of patterns and extent of collateral circulation in patients with known regions of severe stenosis or occlusion.
  • Intraoperative monitoring during carotid surgery.
  • Evaluation and follow-up of patients with vasoconstriction or spasm resulting from an illness, disease or injury, especially after subarachnoid hemorrhage.
  • Detection of arteriovenous (AV) malformations and studying their supply arteries and flow patterns.
  • An adjunct in the assessment of patients with suspected brain death.


Non-covered indications for TCD (considered investigational) include the following:
  • Migraine or headaches.
  • Dizziness not associated with localizing symptoms.
  • Evaluation of patients with dilated vasculopathies, such as fusiform aneurysms.
  • Assessing autoregulation, physiologic and pharmacological responses of cerebral arteries.
  • Evaluating children with various vasculopathies, such as sickle cell disease, moya-moya and neurofibromatosis.
  • Assessment of physiologic and pharmacologic responses of cerebral arteries.


Non-covered indications for TCD (not medically necessary) include the following:
  • Evaluation of brain tumors.
  • Assessment of familial and degenerative disease of the cerebrum, brainstem, cerebellum, basal ganglia and motor neurons.
  • Evaluation of infectious and inflammatory conditions.
  • Evaluation of psychiatric disorder.
  • Evaluation of epilepsy.
  • Routine evaluation of cerebrovascular symptoms and signs.

Non-invasive studies are reasonable and necessary only if the outcome will potentially impact the clinical course of the patient. 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 non-invasive vascular studies are not necessary.
Duplex post-interventional follow-up studies are typically limited in scope and unilateral in nature. The “complete” duplex scan codes should seldom be used, while the “unilateral or limited study” codes should be used (except for the patient who had bilateral intervention).
It is usually unnecessary to perform more than one type of physiological study on the same anatomic area. When an uninterpretable study results in performing another type of study, only the successful study should be billed. Code 93875 will rarely be reimbursed.
It would be expected that a service billed with code 93880 would be used as the initial non-invasive diagnostic test. In rare instances where the service billed with code 93880 is not available, the code 93875 service may be performed where it is reasonable and necessary. Otherwise, 93875 should be substituted with 93880, which has a higher accuracy rate.
Physiologic studies and a duplex scan performed on the same day will be considered medically necessary if there is a 50 percent area stenosis demonstrated on the duplex scan, or there are significant symptoms present (refer to the “Indications and Limitations of Coverage and/or Medical Necessity” section of this policy).

Non-invasive cerebrovascular studies are covered by Medicare when provided in the following places of service:
  • Physician’s office and physician-directed clinic.
  • Outpatient and inpatient hospital.
  • Nursing facilities.
  • Other facilities such as Independent Diagnostic Testing Facilities (IDTFs).

Note: Mobile units are not an appropriate place of service for non-invasive cerebrovascular studies.
Non-invasive cerebrovascular diagnostic studies may be personally performed by a physician or by a technologist. The accuracy of these studies depends on the knowledge, skill and experience of the technologist and physician performing and interpreting the study. Consequently, the physician performing and/or interpreting the study must be capable of demonstrating documented training through recent residency training or postgraduate Continuing Medical Education (CME) and experience and maintain that documentation for postpayment review.

All non-invasive cerebrovascular diagnostic studies, when performed by a technologist, must be performed by a technologist who has demonstrated competency in ultrasound by receiving one of the following credentials in vascular ultrasound technology:
  • Registered Vascular Specialist (RVS) provided by Cardiovascular Credentialing International (CCI).
  • Registered Vascular Technologist (RVT) provided by the American Registry of Diagnostic Medical Sonographers (ARDMS).
  • Vascular Sonographer (VS) provided by the American Registry of Radiologic Technologists, Sonography (ARRT) (S).

Alternately, such studies must be performed in a facility or vascular laboratory accredited by one of the following nationally recognized accreditation organizations:
  • American College of Radiology (ACR) Vascular Ultrasound Accreditation Program.
  • Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL).
If a vascular laboratory or facility is accredited, the technologists performing non-invasive cerebrovascular studies in that laboratory are considered to have demonstrated competency in cerebrovascular ultrasound.
For areas already within TrailBlazer jurisdiction, these credentialing requirements remain unchanged. Otherwise, the effective date for the credentialing requirement is 12/31/2009.

Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.

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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 71X, 83X, 85X
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 policy 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 policy should be assumed to apply equally to all Revenue Codes.



CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
93875©
Extracranial study
93880©
Extracranial study - Fee schedule amount - $188.59
93882©
Extracranial study Fee schedule amount - $ 128.22
93886©
Intracranial study  Fee schedule amount - $185.49 
93888©
Intracranial study Fee schedule amount - $145.71
93890©
Tcd, vasoreactivity study Fee schedule amount - $199.96
93892©
Tcd, emboli detect w/o inj
93893©
Tcd, emboli detect w/ inj

Billing and Coding Guidelines for CPT 93880

CPT 93880 describes bilateral duplex scan of extracranial arteries. Because of the detailed measurement involved in calculating carotid intimal-medial thickness, providers may elect to submit these claims with a --22 modifier (unusual procedural service). In addition, linking the CPT code to the ICD-9 code V81.0 (special screening for cardiovascular disease) may help identify claims.

BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included. 


The below CPTs are not paid seperately unless the proper modifier applied when billed with CPT 93880.

0126T0 76970 76998 93882 93895

Modifier Not Allowed (cannot be billed together):
93880 - 93882
93888 - 93886


In January 2012, the Department of Health Care Services (DHCS) established new policy for CPT-4 codes 93880 (duplex scan of extracranial arteries; complete bilateral study) and 93882 (unilateral or limited study). New policy was established to expand the diagnosis codes for these procedure codes and to reprocess claims billed with diagnosis codes 250.7 – 250.73 (diabetes with peripheral circulatory disorders), 368.10 – 368.12 (subjective visual disturbances), 444 – 444.99 (arterial embolism and thrombosis), 780.2 – 780.29 (syncope and collapse), 780.4 – 780.49 (dizziness and giddiness) and 785.9 – 785.99 (other symptoms involving cardiovascular system) retroactive to April 1, 2011. Xerox State Healthcare, LLC, (Xerox) implemented the new policy on March 29, 2012



ICD-9-CM Codes that Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93875, 93880 and 93882:
Covered for:

237.3
Neoplasm of uncertain behavior of endocrine glands and nervous system, paraganglia
293.0
Delirium due to conditions classified elsewhere
334.3
Other cerebellar ataxia
342.00–342.02
Flaccid hemiplegia
342.10–342.12
Spastic hemiplegia
342.80–342.82
Other specified hemiplegia
342.90–342.92
Hemiplegia, unspecified
344.00–344.04
Quadriplegia and quadriparesis
344.1–344.2
Other paralytic syndromes
344.30–344.32
Monoplegia of lower limbs
344.40–344.42
Monoplegia of upper limbs
344.5
Unspecified monoplegia
344.81
Locked-in state
344.89
Other specified paralytic syndrome
346.01–346.03
Classical migraine
346.12–346.13
Common migraine
346.20–346.23
Variants of migraine
346.31–346.33
Hemiplegic migraine
346.41–346.43
Menstrual migraine
346.51–346.53
Persistent migraine aura without cerebral infarction
346.61–346.63
Persistent migraine aura with cerebral infarction
346.71–346.73
Chronic migraine without aura
346.80–346.83
Other forms of migraine
346.92
Migraine, unspecified, without mention of intractable migraine with status migrainosus
348.1
Anoxic brain damage
348.5
Cerebral edema
362.10–362.18
Other background retinopathy and retinal vascular changes
362.30–362.37
Retinal vascular occlusion
362.84
Retinal ischemia
368.10–368.12
Subjective visual disturbance
368.2
Diplopia
368.40–368.47
Visual field defect
369.61–369.66
Profound impairment, one eye
369.8–369.9
Blindness and low vision
378.50–378.56
Paralytic strabismus
379.50
Nystagmus unspecified
379.52–379.58
Nystagmus and other irregular eye movements
386.2
Vertigo of central origin
388.02
Transient ischemic deafness
389.10
Sensorineural hearing loss unspecified
389.14
Central hearing loss, bilateral
389.18
Sensorineural hearing loss of combined types, bilateral
389.8
Other specified forms of hearing loss
410.00–410.02 begin_of_the_skype_highlighting            00–410.02      end_of_the_skype_highlighting*
Acute myocardial infarction of anterolateral wall
410.10–410.12*
Acute myocardial infarction of other anterolateral wall
410.20–410.22*
Acute myocardial infarction of inferolateral wall
410.30–410.32*
Acute myocardial infarction of inferoposterior wall
410.40–410.42*
Acute myocardial infarction of other inferior wall
410.50–410.52*
Acute myocardial infarction of other lateral wall
410.60–410.62*
Acute myocardial infarction, true posterior wall infarction
410.70–410.72*
Acute myocardial infarction, subendocardial infarction
410.80–410.82*
Acute myocardial infarction, other specified sites
411.0–411.1*
Other acute and subacute forms of ischemic heart disease
411.81*
Acute coronary occlusion without myocardial infarction
411.89*
Other acute and subacute forms of ischemic heart disease other
412*
Old myocardial infarction
413.0–413.1*
Angina pectoris
414.00–414.07 begin_of_the_skype_highlighting            00–414.07      end_of_the_skype_highlighting*
Coronary atherosclerosis
414.10–414.12*
Aneurysm and dissection of heart
414.8*
Other specified forms of chronic ischemic heart disease
430
Subarachnoid hemorrhage
431
Intracerebral hemorrhage
432.0–432.1
Other and unspecified intracranial hemorrhage
433.00–433.01 begin_of_the_skype_highlighting            00–433.01      end_of_the_skype_highlighting
Occlusion and stenosis of basilar artery
433.10–433.11
Occlusion and stenosis of carotid artery
433.20–433.21
Occlusion and stenosis of vertebral artery
433.30–433.31
Occlusion and stenosis of multiple and bilateral precerebral arteries
433.80–433.81
Occlusion and stenosis of other specified precerebral arteries
433.90–433.91
Occlusion and stenosis of unspecified precerebral arteries
434.00–434.01 begin_of_the_skype_highlighting            00–434.01      end_of_the_skype_highlighting
Occlusion of cerebral arteries, thrombosis
434.10–434.11
Occlusion of cerebral arteries, embolism
434.90–434.91
Occlusion of cerebral arteries, unspecified
435.0–435.3
Transient cerebral ischemia
435.8–435.9
Transient cerebral ischemia
436
Acute, but ill-defined cerebrovascular disease
437.0–437.8
Other and ill-defined cerebrovascular disease
438.0
Cognitive deficits
438.10–438.12
Speech and language deficits
438.20–438.22
Hemiplegia/hemiparesis
438.30–438.32
Monoplegia of upper limb
438.40–438.42
Monoplegia of lower limb
438.50–438.53
Other paralytic syndrome
438.6–438.7
Late effects of cerebrovascular disease
438.81–438.85
Other late effects of cerebrovascular disease
438.89
Other late effects of cerebrovascular disease
440.0–440.1*
Atherosclerosis
440.20–440.24*
Atherosclerosis of native arteries of the extremities
440.29*
Other atherosclerosis of native arteries of the extremities
440.30–440.32*
Atherosclerosis of bypass graft of the extremities
442.81–442.82
Other aneurysm of other specified artery
443.21
Dissection of carotid artery
443.24
Dissection of vertebral artery
446.0–446.1
Polyarteritis nodosa and allied conditions
446.20–446.21
Hypersensitivity angiitis
446.29
Other specified hypersensitivity angiitis
446.3–446.7
Polyarteritis nodosa and allied conditions
447.0–447.2
Other disorders of arteries and arterioles
447.6
Arteritis unspecified
447.8–447.9
Other disorders of arteries and arterioles
747.81
Congenital anomalies of cerebrovascular system
780.02
Transient alteration of awareness
780.2
Syncope and collapse
Note: Report 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.
781.2–781.4
Symptoms involving nervous and musculoskeletal system
781.94
Facial weakness
782.0
Disturbance of skin sensation
784.2
Swelling, mass or lump in head and neck
Note: Use 784.2 to report pulsatile neck mass.
784.3
Aphasia
784.40
Voice disturbance unspecified
784.51
Dysarthria
784.52
Fluency disorder in conditions classified elsewhere
784.59
Other speech disturbance
785.9
Other symptoms involving cardiovascular system
Note: Use 785.9 to report carotid bruit.
787.20-787.24
Dysphagia
787.29
Other dysphagia
900.00–900.03
Injury to carotid artery
900.1
Injury to internal jugular vein
900.81–900.82
Injury to other specified blood vessels of head and neck
900.89
Injury to other blood vessels of head and neck
900.9
Injury to unspecified blood vessel of head and neck
901.1
Injury to innominate and subclavian arteries
958.4
Traumatic shock
996.1
Mechanical complication of other vascular device, implant and graft
996.74
Other complications due to vascular device, implant and graft
998.0
Postoperative shock
998.11–998.13
Hemorrhage or hematoma or seroma complicating a procedure
998.2
Accidental puncture or laceration during a procedure
998.30–998.33
Disruption of operation wound
998.4
Foreign body accidentally left during a procedure
998.6–998.7
Other complications of procedures, not elsewhere classified
V43.4
Blood vessel replaced by other means
V45.89
Other post-surgical status
V58.73
Aftercare following surgery of the circulatory system not elsewhere classified
V67.00
Follow-up examination, following unspecified surgery
V67.09
Follow-up examination, following other surgery
Note: For ICD-9-CM diagnosis codes above identified with an asterisk (*), refer to the section below titled “Diagnoses that Support Medical Necessity.”
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93886, 93888, 93890, 93892 and 93893:
Covered for:
348.89
Other conditions of brain
Note: Use 348.89 to identify assessment of suspected brain death.
362.30–362.37
Retinal vascular occlusion
362.84
Retinal ischemia
368.10–368.12
Subjective visual disturbance
368.2
Diplopia
368.40–368.47
Visual field defects
430
Subarachnoid hemorrhage
431
Intracerebral hemorrhage
433.00–433.01 begin_of_the_skype_highlighting            00–433.01      end_of_the_skype_highlighting
Occlusion and stenosis of basilar artery
433.10–433.11
Occlusion and stenosis of carotid artery
433.20–433.21
Occlusion and stenosis of vertebral artery
433.80–433.81
Occlusion and stenosis of other specified precerebral artery
433.90–433.91
Occlusion and stenosis of unspecified cerebral artery
434.00–434.01 begin_of_the_skype_highlighting            00–434.01      end_of_the_skype_highlighting
Occlusion of cerebral arteries, thrombosis, with/without mention of cerebral infarction
434.10–434.11
Occlusion of cerebral arteries, embolism, with/without mention of cerebral infarction
434.90–434.91
Occlusion of cerebral arteries
435.0–435.3
Transient cerebral ischemia
435.8–435.9
Transient cerebral ischemia
436
Acute, but ill-defined cerebrovascular disease
437.0–437.1
Other and ill-defined cerebrovascular disease
437.3–437.5
Other and ill-defined cerebrovascular disease
437.7
Transient global amnesia
437.9
Unspecified, cerebrovascular disease or lesion
442.81–442.82
Other aneurysm of other specified artery
444.9
Arterial embolism and thrombosis of unspecified artery
Note: Use 444.9 to report paradoxical cerebral embolism.
446.0–446.1
Polyarteritis nodosa and allied conditions
446.20–446.21
Hypersensitivity angiitis
446.29
Other specified hypersensitivity angiitis
447.0–447.2
Other disorders of arteries and arterioles
447.6
Arteritis unspecified
447.8–447.9
Other disorders of arteries and arterioles
780.2
Syncope and collapse
Note: Report 780.2 when symptomatology indicates a strong clinical suspicion of vertebrobasilar insufficiency.
781.2–781.5
Symptoms involving nervous and musculoskeletal system
782.0
Disturbance of skin sensation
784.3
Aphasia
784.51
Dysarthria
784.52
Fluency disorder in conditions classified elsewhere
784.59
Other speech disturbance
785.9
Other symptoms involving cardiovascular system
Note: Use 785.9 to report carotid bruit.
900.00–900.03
Injury to carotid artery
900.1
Injury to internal jugular vein
900.81–900.82
Injury to other specified blood vessels of head and neck
900.89
Injury to other blood vessels of head and neck
900.9
Injury to unspecified blood vessel of head and neck
901.1
Injury to innominate and subclavian arteries
958.4
Traumatic shock
996.1
Mechanical complication of other vascular device, implant, and graft
996.74
Other complication due to other vascular device, implant and graft
998.11–998.13
Hemorrhage or hematoma or seroma complicating a procedure
998.2
Accidental puncture or laceration during a procedure
998.30–998.33
Disruption of operation wound
998.4
Foreign body accidentally left during a procedure
998.6–998.7
Other complications of procedures, not elsewhere classified
V43.4
Blood vessel replaced by other means
V67.00
Follow-up examination, following unspecified surgery
V67.09

Follow-up examination, following other surgery
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses that Support Medical Necessity
Medicare expects that one of the “V”-codes listed below be billed as the primary diagnosis when billing CPT/HCPCS codes 93875, 93880 and 93882 for preoperative evaluation of selected patients scheduled for major cardiovascular surgical procedures who, because of their clinical history and/or presentation, places them at increased risk of intraoperative or perioperative stroke. The claim should also include one of the ICD-9-CM codes identified with an asterisk (*) in the limited coverage list above for CPT codes 93875, 93880 and 93882.
V72.81
Pre-operative cardiovascular examination
V72.83
Other specified pre-operative examination

Diagnoses that DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.
Documentation Requirements
Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
Vascular studies include supervision and interpretation of the study and its results. A hard copy or soft copy convertible to a hard copy provides a permanent record of the study performed and must be of a quality that meets accepted medical standards. These studies also include the patient care required to perform them.
When using syncope as an indication, it is necessary to document that other, more common causes have been ruled out.
When requesting a written redetermination (formerly appeal), providers must include all relevant documentation with the request.

Utilization Guidelines
For follow-up of patients with known carotid disease who are receiving medical therapy:
  • Stenosis of 20 percent to 50 percent (diameter reduction), annual study.
  • Stenosis of 50 percent to 99 percent (every six months). Medicare expects that few patients with high-grade carotid stenosis (79-99 percent) will be followed medically with repeated diagnostic testing. Because surgery is usually indicated for stenosis of 80 percent to 99 percent, the medical record of patients followed medically with high-grade stenosis must unequivocally indicate medical necessity for repeated diagnostic testing.
  • Medicare would not expect, after carotid endarterectomy, that repeat examinations occur more frequently than at six weeks, six months, 12 months and yearly, thereafter. Postoperatively, follow-up studies should be unilateral unless signs and symptoms or known contralateral stenosis provide indications for a bilateral procedure.
Notice: This LCD imposes utilization guideline limitations. Despite Medicare’s allowing up to these maximums, each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each service reported to be clearly demonstrated in the patient’s medical record. Medicare expects that patients will not routinely require the maximum allowable number of services.
Sources of Information and Basis for Decision
United States Government Accountability Office, Medicare Ultrasound Procedures, Consideration of payment reforms and technician qualification requirements. June 2007.
J4 (CO, NM, OK, TX) MAC Integration
TrailBlazer adopted, with inclusion of additional diagnoses, the TrailBlazer LCD, “Non-Invasive Cerebrovascular Studies,” for the Jurisdiction 4 (J4) MAC transition.
Full disclosure of information sources is found with the original contractor LCD.

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