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National Coverage Determination (NCD)

Cardiac Output Monitoring by Electrical Bioimpedance

50-54

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Tracking Information

Publication Number
6
Manual Section Number
50-54
Manual Section Title
Cardiac Output Monitoring by Electrical Bioimpedance
Version Number
1
Effective Date of this Version
07/01/1999
Ending Effective Date of this Version
01/23/2004
Implementation Date
07/01/1999
Implementation QR Modifier Date

Description Information

Benefit Category
Diagnostic Tests (other)


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

These devices utilize electrical bioimpedance to noninvasively produce hemodynamic measurements of cardiac output, specifically, stroke volume, contractility, systemic vascular resistance and thoracic fluid content.
Indications and Limitations of Coverage

Cardiac monitoring using electrical bioimpedance, a form of plethysmography, is covered, effective for services furnished on or after July 1, 1999, for the uses and conditions described below. Contractors should be aware that this technology is in the process of being proven for additional uses. Therefore, the uses below represent the current situation. Contractors may cover additional uses when they believe there is sufficient evidence of the medical effectiveness of such uses.

These devices are covered for the following uses:

  1. Noninvasive diagnosis or monitoring of hemodynamics in patients with suspected or known cardiovascular disease;
  2. Differentiation of cardiogenic from pulmonary causes of acute dyspnea;
  3. Optimization of atrioventricular interval for patient with A/V sequential cardiac pacemakers;
  4. Patients with need of determination for intravenous inotropic therapy;
  5. Post heart transplant myocardial biopsy patients; and,
  6. Patients with a need for fluid management.

Not covered at this time are the use of such devices for any monitoring of patients with proven or suspected disease involving severe regurgitation of the aorta, or for patients with minute ventilation (MV) sensor function pacemakers, since the device may adversely affect the functioning of that type of pacemaker. Also, these devices do not render accurate measurements in cardiac bypass patients while on a cardiolpulmonary bypass machine, but do provide accurate measurements prior to and post bypass pump.

Covered uses of cardiac output monitoring by electrical bioimpedance should be billed using HCPCS code M0302.
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
109
Revision History

04/1999 - Limited coverage for six uses. Contractors may cover additional uses when they believe there is sufficient evidence of medical effectiveness of such uses. Effective date 07/01/1999. (TN 109) (CR 827)

08/1989 - Excluded from coverage. Effective date 08/25/1989. (TN 38)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB) 3 11/24/2006 - N/A View
Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB) 2 01/23/2004 - 11/24/2006 View
Cardiac Output Monitoring by Electrical Bioimpedance 1 07/01/1999 - 01/23/2004 You are here
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Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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