Pharmacologic Nuclear Stress Testing in Response to COVID-19 for Medicare Advantage Members (Updated April 16, 2021)
MA09.002p High-Technology Radiology Services
The purpose of this News Article is to provide advance notice regarding the use of pharmacologic stress testing with nuclear imaging in response to the Public Health Emergency (PHE) for the COVID-19 pandemic.
This communication addressing pharmacologic stress testing with nuclear imaging is effective from March 6, 2020 and will be reevaluated for continuing applicability on June 30, 2021.
There is currently an outbreak of respiratory disease caused by a novel coronavirus, which has now been detected both nationally and internationally. The virus has been named “SARS-CoV-2” and the disease it causes has been named “Coronavirus Disease 2019” (COVID-19). The SARS-CoV-2 virus has demonstrated the capability to rapidly spread, leading to significant impacts on healthcare systems and causing societal disruption. The potential public health threat posed by COVID-19 is high globally. To effectively respond to the COVID-19 outbreak, rapid detection of cases and contacts, appropriate clinical management and infection control, and implementation of community mitigation efforts are critical.
A cardiovascular stress test using treadmill or bicycle exercise with continuous electrocardiographic monitoring in individuals with COVID-19 may lead to disease exposure to others because of deep breathing and/or coughing during exercise. In accordance with the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI), these tests should generally be deferred when non-urgent, or, when they cannot be deferred, converted to a pharmacologic stress test using nuclear imaging. Conversion to a pharmacologic stress test using nuclear imaging may minimize the risk of viral exposure and transmission to healthcare personnel and individuals during the COVID-19 pandemic.
In response to Coronavirus Disease 2019 (COVID-19), a pharmacologic stress test using nuclear imaging is covered in lieu of a cardiovascular stress test using treadmill or bicycle exercise with continuous electrocardiographic monitoring, when the provider indicates a stress test is medically necessary and cannot be deferred.
For the Company's plans that are subject to radiology utilization management through AIM Specialty Health® (AIM) for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services, AIM will apply the above coverage criteria to determine the medical necessity for these services. To view AIM’s current and future guidelines, go to the Resources section of AIM’s website, available at https://aimspecialtyhealth.com/resources/.
Dosing and Administration
Black Box Warnings and/or Contraindications
78430, 78431, 78451, 78452, 78453, 78454, 78491, 78492