Aetna · Clinical coverage policy

Aetna Color-Flow Doppler Echocardiography coverage criteria

Aetna covers color-flow Doppler echocardiography in adults for a defined list of cardiac indications (e.g., angina, valvular and aortic disease, cardiomyopathy, heart failure, murmur, pericardial effusion, prosthetic valves, septal defects/shunts, monitoring after tetralogy of Fallot repair or during cardiotoxic chemotherapy), and considers it experimental/investigational for all other indications. It also covers myocardial strain imaging in adults only for specific gated scenarios — LVH initial workup with both unclear etiology and infiltrative-cardiomyopathy concern, heart transplant evaluation/surveillance per protocol, and cardiotoxic-agent therapy monitoring — while treating it as not medically necessary or experimental for kidney/liver transplant candidacy and various pediatric/asymptomatic uses.

Policy CPB 0008 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0008

Prior auth

Confirm

Effective

June 18, 1997

This page reflects the coverage criteria captured from Aetna policy CPB 0008 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Color-Flow Doppler Echocardiography (CPT 93303), and what gets it denied?

Path
Aetna covers color-flow Doppler echocardiography in adults for a defined list of cardiac indications (e.g., angina, valvular and aortic disease, cardiomyopathy, heart failure, murmur, pericardial effusion, prosthetic valves, septal defects/shunts, monitoring after tetralogy of Fallot repair or during cardiotoxic chemotherapy), and considers it experimental/investigational for all other indications. It also covers myocardial strain imaging in adults only for specific gated scenarios — LVH initial workup with both unclear etiology and infiltrative-cardiomyopathy concern, heart transplant evaluation/surveillance per protocol, and cardiotoxic-agent therapy monitoring — while treating it as not medically necessary or experimental for kidney/liver transplant candidacy and various pediatric/asymptomatic uses. Coverage criteria include: Color-flow Doppler echocardiography (adults) medically necessary: during excision of left atrial mass; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of angina; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortic diseases; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortocoronary bypass grafts; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of atrial fibrillation/flutter; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac function after Fontan procedure; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac tamponade; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiomyopathy (including hypertrophic cardiomyopathy); Color-flow Doppler echocardiography (adults) medically necessary: evaluation of congestive heart failure; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of dyspnea (shortness of breath); Color-flow Doppler echocardiography (adults) medically necessary: evaluation of heart murmur; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pericardial effusion; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of prosthetic valves; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pulmonary hypertension; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of septal defects; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of site of left-to-right or right-to-left shunts; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of valvular diseases (mitral regurgitation; severity of valve stenosis); Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals after repair of tetralogy of Fallot; Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals receiving cardiotoxic chemotherapy; Color-flow Doppler echocardiography (adults) medically necessary: status post episode of ventricular tachycardia; Myocardial strain imaging (adults) medically necessary when ANY one of the listed criteria is met (criteria below); Myocardial strain imaging medically necessary — Left Ventricular Hypertrophy (LVH) initial evaluation: in addition to primary echocardiogram, when documentation includes BOTH: unclear etiology AND concern for infiltrative cardiomyopathy; Myocardial strain imaging medically necessary — Heart transplant evaluation and surveillance: per transplant protocol; Myocardial strain imaging medically necessary — Cardiotoxic agent therapy (in addition to primary echocardiogram), when ONE of: initial evaluation prior to treatment with medications causing cardiotoxicity/heart failure or radiation causing cardiotoxicity/heart failure OR re-evaluation if echocardiogram shows new abnormality OR re-evaluation every 3 months or with worsening symptoms OR initial post-treatment evaluation 3-12 months after completion OR periodic surveillance for medium- and high-risk survivors. Applies to 10 codes: 93303, 93304, 93306, 93307, 93308, 93312, 93315, 93318, 93350, 93351.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: For myocardial strain imaging in LVH initial evaluation: documentation including BOTH unclear etiology AND concern for infiltrative cardiomyopathy.
Trap
Policy exclusions and limitations: Color-flow Doppler echocardiography is considered experimental, investigational, or unproven for all other indications because its effectiveness has not been established, including to guide catheter ablation in ventricular tachycardia; Myocardial strain imaging is considered not medically necessary for evaluating kidney or liver transplant candidacy; Myocardial strain imaging is considered experimental, investigational, or unproven for risk stratification in asymptomatic adults with repaired tetralogy of Fallot (in addition to primary echocardiogram); Myocardial strain imaging is considered experimental, investigational, or unproven for children with atrial septal defect (ASD); Myocardial strain imaging is considered experimental, investigational, or unproven for risk assessment or directing asymptomatic management in children. Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0008 — Color-Flow Doppler Echocardiography

Coverage criteria

  • Color-flow Doppler echocardiography (adults) medically necessary: during excision of left atrial mass
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of angina
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortic diseases
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortocoronary bypass grafts
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of atrial fibrillation/flutter
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac function after Fontan procedure
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac tamponade
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiomyopathy (including hypertrophic cardiomyopathy)
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of congestive heart failure
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of dyspnea (shortness of breath)
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of heart murmur
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pericardial effusion
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of prosthetic valves
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pulmonary hypertension
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of septal defects
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of site of left-to-right or right-to-left shunts
  • Color-flow Doppler echocardiography (adults) medically necessary: evaluation of valvular diseases (mitral regurgitation; severity of valve stenosis)
  • Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals after repair of tetralogy of Fallot
  • Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals receiving cardiotoxic chemotherapy
  • Color-flow Doppler echocardiography (adults) medically necessary: status post episode of ventricular tachycardia
  • Myocardial strain imaging (adults) medically necessary when ANY one of the listed criteria is met (criteria below)
  • Myocardial strain imaging medically necessary — Left Ventricular Hypertrophy (LVH) initial evaluation: in addition to primary echocardiogram, when documentation includes BOTH: unclear etiology AND concern for infiltrative cardiomyopathy
  • Myocardial strain imaging medically necessary — Heart transplant evaluation and surveillance: per transplant protocol
  • Myocardial strain imaging medically necessary — Cardiotoxic agent therapy (in addition to primary echocardiogram), when ONE of: initial evaluation prior to treatment with medications causing cardiotoxicity/heart failure or radiation causing cardiotoxicity/heart failure OR re-evaluation if echocardiogram shows new abnormality OR re-evaluation every 3 months or with worsening symptoms OR initial post-treatment evaluation 3-12 months after completion OR periodic surveillance for medium- and high-risk survivors

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Documentation required

  • For myocardial strain imaging in LVH initial evaluation: documentation including BOTH unclear etiology AND concern for infiltrative cardiomyopathy

Frequently asked questions

When does Aetna cover Color-Flow Doppler Echocardiography (CPT 93303), and what gets it denied?
Aetna covers color-flow Doppler echocardiography in adults for a defined list of cardiac indications (e.g., angina, valvular and aortic disease, cardiomyopathy, heart failure, murmur, pericardial effusion, prosthetic valves, septal defects/shunts, monitoring after tetralogy of Fallot repair or during cardiotoxic chemotherapy), and considers it experimental/investigational for all other indications. It also covers myocardial strain imaging in adults only for specific gated scenarios — LVH initial workup with both unclear etiology and infiltrative-cardiomyopathy concern, heart transplant evaluation/surveillance per protocol, and cardiotoxic-agent therapy monitoring — while treating it as not medically necessary or experimental for kidney/liver transplant candidacy and various pediatric/asymptomatic uses. Coverage criteria include: Color-flow Doppler echocardiography (adults) medically necessary: during excision of left atrial mass; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of angina; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortic diseases; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of aortocoronary bypass grafts; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of atrial fibrillation/flutter; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac function after Fontan procedure; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiac tamponade; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of cardiomyopathy (including hypertrophic cardiomyopathy); Color-flow Doppler echocardiography (adults) medically necessary: evaluation of congestive heart failure; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of dyspnea (shortness of breath); Color-flow Doppler echocardiography (adults) medically necessary: evaluation of heart murmur; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pericardial effusion; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of prosthetic valves; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of pulmonary hypertension; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of septal defects; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of site of left-to-right or right-to-left shunts; Color-flow Doppler echocardiography (adults) medically necessary: evaluation of valvular diseases (mitral regurgitation; severity of valve stenosis); Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals after repair of tetralogy of Fallot; Color-flow Doppler echocardiography (adults) medically necessary: monitoring individuals receiving cardiotoxic chemotherapy; Color-flow Doppler echocardiography (adults) medically necessary: status post episode of ventricular tachycardia; Myocardial strain imaging (adults) medically necessary when ANY one of the listed criteria is met (criteria below); Myocardial strain imaging medically necessary — Left Ventricular Hypertrophy (LVH) initial evaluation: in addition to primary echocardiogram, when documentation includes BOTH: unclear etiology AND concern for infiltrative cardiomyopathy; Myocardial strain imaging medically necessary — Heart transplant evaluation and surveillance: per transplant protocol; Myocardial strain imaging medically necessary — Cardiotoxic agent therapy (in addition to primary echocardiogram), when ONE of: initial evaluation prior to treatment with medications causing cardiotoxicity/heart failure or radiation causing cardiotoxicity/heart failure OR re-evaluation if echocardiogram shows new abnormality OR re-evaluation every 3 months or with worsening symptoms OR initial post-treatment evaluation 3-12 months after completion OR periodic surveillance for medium- and high-risk survivors. Applies to 10 codes: 93303, 93304, 93306, 93307, 93308, 93312, 93315, 93318, 93350, 93351. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: For myocardial strain imaging in LVH initial evaluation: documentation including BOTH unclear etiology AND concern for infiltrative cardiomyopathy. Policy exclusions and limitations: Color-flow Doppler echocardiography is considered experimental, investigational, or unproven for all other indications because its effectiveness has not been established, including to guide catheter ablation in ventricular tachycardia; Myocardial strain imaging is considered not medically necessary for evaluating kidney or liver transplant candidacy; Myocardial strain imaging is considered experimental, investigational, or unproven for risk stratification in asymptomatic adults with repaired tetralogy of Fallot (in addition to primary echocardiogram); Myocardial strain imaging is considered experimental, investigational, or unproven for children with atrial septal defect (ASD); Myocardial strain imaging is considered experimental, investigational, or unproven for risk assessment or directing asymptomatic management in children. Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Color-Flow Doppler Echocardiography?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: For myocardial strain imaging in LVH initial evaluation: documentation including BOTH unclear etiology AND concern for infiltrative cardiomyopathy.
What does Aetna exclude for Color-Flow Doppler Echocardiography?
Policy exclusions and limitations: Color-flow Doppler echocardiography is considered experimental, investigational, or unproven for all other indications because its effectiveness has not been established, including to guide catheter ablation in ventricular tachycardia; Myocardial strain imaging is considered not medically necessary for evaluating kidney or liver transplant candidacy; Myocardial strain imaging is considered experimental, investigational, or unproven for risk stratification in asymptomatic adults with repaired tetralogy of Fallot (in addition to primary echocardiogram); Myocardial strain imaging is considered experimental, investigational, or unproven for children with atrial septal defect (ASD); Myocardial strain imaging is considered experimental, investigational, or unproven for risk assessment or directing asymptomatic management in children. Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0008 — Color-Flow Doppler Echocardiography

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0008 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.