LCD Reference Article Billing and Coding Article

Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

A58095

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
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Article ID
A58095
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
Article Type
Billing and Coding
Original Effective Date
04/26/2021
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
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CMS National Coverage Policy

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Article Guidance

Article Text

The information in the Supplemental Instructions Article contains billing, coding, or other guidelines that complement the Noridian Local Coverage Determination for Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease L38613.

Procedure codes may be subject to National Correct Coding Initiative edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.  

As this service constitutes post-procedure analysis of a previously performed study (CCTA), the name and National Provider Identifier (NPI) of the referring/ordering physician that submitted imaging data for FFRct review must be reported on the claim.

An Advance Beneficiary Notice (ABN) of non-coverage may be used for services that are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30 for complete instructions.

The patient’s medical record must document all of the following:

  1. The clinical findings that led to the initial performance of the CCTA, and the CCTA must be fully reviewed before the performance of FFRct. (as evidenced by the submission of the Coronary Computed Tomographic Angiography Report)
  2. Description of symptoms consistent with stable ischemic heart disease.
  3. Body mass index
  4. Fractional Flow Reserve analysis report

Response To Comments

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1
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Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

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Use of this code does not guarantee reimbursement. The patient’s medical record must document that the coverage criteria in the related policy have been met.

Group 1 Codes
Code Description
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R3

Under CPT/HCPCS Codes Group 1:

Removed HCPCS 0501T, 0502T, 0503T, 0504T.

Added CPT 75580

Changes were made due to CPT/HCPCS codes update effective 1/1/2024.

09/18/2022 R2

Updated to indicate this article is an LCD Reference Article.

09/18/2022 R1

Removed stable from the article title as policy now encompasses both acute and stable scenarios.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
12/20/2023 01/01/2024 - N/A Currently in Effect You are here
11/16/2023 09/18/2022 - 12/31/2023 Superseded View
07/27/2022 09/18/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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