Contrast agents used in conjunction with covered diagnostic or therapeutic echocardiography procedures (e.g., perflexane, octafluoropropane, perflutren) 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 claim payment reimbursement for the associated procedure and, therefore, are not eligible for separate reimbursement. Participating providers may not bill members for this service.
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.