About this policy
The information in the Supplemental Instructions Article contains billing, coding, or other guidelines that complement the Noridian Local Coverage Determination LCD for Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease L38278. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or Outpatient Prospective Payment System (OPPS) packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. As this service constitutes post-procedure analysis of a previously performed study (coronary computed tomography angiography (CCTA)), the name and National Provider Identifier (NPI) of the referring/ordering physician that submitted imaging data for FFRct review must be reported on the claim. An Advance Beneficiary Notice (ABN) of non-coverage may be used for services that are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 30 Financial Liability Protections for complete instructions. The patient’s medical record must document all of the following: The clinical findings that led to the initial performance of the CCTA, and the CCTA must be fully reviewed before the performance of FFRct (as evidenced by the submission of the Coronary Computed Tomographic Angiography Report). Description of symptoms consistent with stable ischemic heart disease. Body mass index. Fractional Flow Reserve analysis report.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.