Does A9700 require prior authorization?

No, A9700 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for A9700?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9700`, Supply of injectable contrast material for use in echocardiography, per study

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.

Document use of ultrasound contrast enhancement and its supplies separately when billed, and do not submit separate claims for diagnostic injection services integral to the contrast procedure.

Follow the Local Coverage Determination L37379 and include documentation sufficient to support medical necessity when multiple imaging studies are billed.

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.

Key Coverage Criteria

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Echocardiograms performed as part of the CAMZYOS REMS program are covered when billed with modifier KX and all REMS program requirements are met for patients with NYHA Class II–III obstructive hypertrophic cardiomyopathy (I42.1).

12 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

PALMETTO-JJ-L37379, Echocardiography

PALMETTO-JJ-L38786, Echocardiography for Myocardial Perfusion

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

PALMETTO-JM-L38786, Echocardiography for Myocardial Perfusion

PALMETTO-JM-L37379, Echocardiography

A58503, Billing and Coding: Echocardiography for Myocardial Perfusion

A56625, Billing and Coding: Echocardiography

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

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A9700, Supply of injectable contrast material for use in echocardiography, per study