Commercial

Contrast Agents Used in Conjunction with Echocardiography
09.00.11e

Policy

Contrast agents (e.g., perflexane, octafluoropropane, perflutren) used in conjunction with covered diagnostic or therapeutic echocardiography procedures are covered and eligible for reimbursement consideration by the Company when performed by a professional provider in the office setting.

Contrast agents used in conjunction with diagnostic or therapeutic echocardiography procedures administered in the facility setting are included in the reimbursement for the associated procedure and, therefore, are not eligible for separate reimbursement. Participating providers may not bill members for this service.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, the following: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines



Description

Contrast agents, also known as contrast media, are chemicals that enable visualization of tissues or organs by increasing contrast during echocardiography, radiography, or other imaging techniques. During echocardiography, utilizing contrast agents also enables the real-time assessment of intracardiac blood flow. During an echocardiographic procedure, as sound travels from one medium to another, changes in the density at the interface cause reflection of the sound waves. Greater differences in density result in a more echogenic interface and improved visualization. Gas-containing contrast agents routinely utilized as gas are 100,000 times less dense than blood.

The contrast agents used during echocardiography consist of microspheres of gas encased within a thin biocompatible shell composed of protein, lipid, or polymers. Their small size and durability allows the microspheres to remain within the vascular system and to flow through the pulmonary circulation to the systemic circulation following peripheral injections. There are currently three principally different agents available:
  • Air with a galactose and palmitic acid as a surfactant
  • Octafluoropropane within an albumin shell or lipid shell
  • Sulfur hexafluoride with a phospholipid shell
The gas contained within the microspheres diffuses through the shells within a half-life of a few minutes in blood, ultimately diffusing into the lungs during pulmonary circulation.

References

Andreas, Adam, Dixon, Adrain K., Gillard, Jonathan H., and Schaefer-Prokop, Cornelia M. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging. 6th edition. Elsevier Limited, 2015.

Brant MD, William E., Helms MD, Clyde A., Klein MD FACR, JeffreyJennifer PohlVinson MD, Emily N. Fundamentals of Diagnostic Radiology .5th edition. Philadelphia: Lippincott, Williams & Wilkins. 2018.

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing. Transmittals for Chapter 12, 30.4 - Cardiovascular System (Codes 92950-93799), A. Echocardiography Contrast Agents. [CMS Web site]. 07/25/19. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf. Accessed February, 09, 2021.

Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing. Transmittals for Chapter 12, 30.4 - Cardiovascular System (Codes 92950-93799), A. Echocardiography Contrast Agents. [CMS Web site]. 07/25/19. Available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf. Accessed February 09, 2021.

Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)
N/A

HCPCS Level II Code Number(s)

A9700Supply of injectable contrast material for use in echocardiography, per study
Q9950Injection, sulfur hexafluoride lipid microspheres, per ml
Q9955Injection, perflexane lipid microspheres, per ml
Q9956Injection, octafluoropropane microspheres, per ml
Q9957Injection, perflutren lipid microspheres, per ml​




Revenue Code Number(s)
N/A



Coding and Billing Requirements


Policy History

5/3/2021
5/3/2021
09.00.11
Claim Payment Policy Bulletin
Commercial
No