Do not routinely pay for the following diagnostic tests because they are obsolete and have been replaced by more advanced procedures. The listed tests may be paid for only if the medical need for the procedure is satisfactorily justified by the physician who performs it. When the services are subject to the Quality Improvement Organization (QIO) Review, the QIO is responsible for determining that satisfactory medical justification exists. When the services are not subject to QIO review, the intermediary or carrier is responsible for determining that satisfactory medical justification exists. This includes:
Serum seromucoid assay for cancer and other diseases.
B. Cardiovascular Tests
Do not pay for the following phonocardiography and vectorcardiography diagnostic tests because they have been determined to be outmoded and of little clinical value. They include:
Phonocardiogram with or without ECG lead; with supervision during recording with interpretation and report (when equipment is supplied by the physician),
Phonocardiogram; tracing only, without interpretation and report (e.g., when equipment is supplied by the hospital, clinic),
Phonocardiogram; interpretation and report,
Phonocardiogram with ECG lead, with indirect carotid artery and/or jugular vein tracing, and/or apex cardiogram; with interpretation and report,
Phonocardiogram; without interpretation and report,
Phonocardiogram; interpretation and report only,
Intracardiac,
Vectorcardiogram (VCG), with or without ECG; with interpretation and report,
Vectorcardiogram; tracing only, without interpretation and report, and
Vectorcardiogram; interpretation and report only.
Revision History
04/01/1997 - Excluded coverage of 10 phonocardiography and vectorcardiography diagnostic tests. Effective 1/1/1997. (TN 96)
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