When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
I45.81 Long QT syndrome
THE FOLLOWING CODES ARE USED TO REPRESENT SIGNS AND SYMPTOMS
R55 Syncope and collapse
R42 Dizziness and giddiness
R94.31 Abnormal electrocardiogram [ECG] [EKG]
Z82.41 Family history of sudden cardiac death
Z84.81 Family history of carrier of genetic disease
THE FOLLOWING CODES ARE USED TO REPRESENT GENETIC TESTING SCREENING
Z13.71 Encounter for nonprocreative screening for genetic disease carrier status
Z13.79 Encounter for other screening for genetic and chromosomal anomalies
Policy: 00.01.25av:PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services