Does Q9955 require prior authorization?

No, Q9955 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for Q9955?

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

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`Q9955`, Injection, perflexane lipid microspheres, per ml

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

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.

Key Coverage Criteria

CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
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.

12 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NOVITAS-JH-L35016, Transesophageal Echocardiography (TEE)

PALMETTO-JJ-L38786, Echocardiography for Myocardial Perfusion

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

A56505, Billing and Coding: Transesophageal Echocardiography (TEE)

NOVITAS-JL-L35016, Transesophageal Echocardiography (TEE)

PALMETTO-JM-L38786, Echocardiography for Myocardial Perfusion

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

A58503, Billing and Coding: Echocardiography for Myocardial Perfusion

`Q9955`, Injection, perflexane lipid microspheres, per ml

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

12 Active Policies

Related Codes

Have a follow-up question?

Q9955, Injection, perflexane lipid microspheres, per ml

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

12 Active Policies

Related Codes

Have a follow-up question?

`Q9955`, Injection, perflexane lipid microspheres, per ml