Prevention magazine selected EndoPAT among top medical breakthroughs

CODING FOR EndoPAT TEST

Physicians and hospitals should use independent judgment when selecting codes that most appropriately describe the services rendered to a patient, and are responsible for compliance with individual insurance company billing and reimbursement requirements. The AMA advises physicians to select the CPT code that most accurately identifies the service performed.

CPT 93923: Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels with provocative functional maneuvers, complete bilateral study (e.g., segmental blood pressure measurements, segmental Doppler waveform analysis, volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia).

ICD-9-CM DIAGNOSIS CODES

Diagnosis codes used on a patient’s claim form should accurately reflect the patient’s condition and diagnosis(es) and must be coded to the highest level of specificity. Refer to applicable payer coverage policies for guidance regarding specific ICD-9-CM diagnosis codes that may support medical necessity for a given diagnostic test.

MEDICARE COVERAGE

Specific indications and /or limitations for coverage may vary by Medicare Carrier or A/B MAC. Providers should refer to their Medicare Carrier’s or A/B MAC’s Local Coverage Decision (LCD) for specific coverage and billing guidelines or you may contact the EndoPAT Customer Support for assistance.

PRIVATE PAYERS

Coverage guidelines and payment levels will vary by payer and specific plan. Some payers may have specific requirements for using certain codes, including prior authorization, limitations on medical diagnoses, or specialty provider types. Providers should contact the specific plan to determine coverage and payment for the use of Itamar Medical’s EndoPAT or contact the EndoPAT Customer Support for assistance.