simpleABI Vascular Reimbursement Information
Would you like to know the most current simpleABI vascular reimbursement for PAD testing in 2023? As part of our commitment to advocate for effective vascular care, we have gathered the reimbursement information for vascular studies to help you plan ahead for the year. If you are interested in how much you will be paid for basic vascular testing, multi-level vascular testing, and post-exercise testing, the tools below will be a valuable resource.
Diagnosis of PAD is covered under several CPT codes, including:
- CPT code 93922 – a basic test for a single level bilateral study of upper or lower extremities
- CPT code 93923 – expands testing to three or more levels of the extremities to attempt to localize the occlusion OR provides for pre and post exercise testing utilizing provocative maneuvers.
- CPT code 93924 – provides for treadmill testing utilizing a specific protocol.
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Annual simpleABI Vascular Reimbursement Information
- Current State by State CPT Code Reimbursement
- Current State by State Accreditation Requirements – View or Share
- Current ICD-10 Code Information – View or Share
- Latest Update on simpleABI Vascular Reimbursement Criteria – View or Share
American Heart Association & American College of Cardiology Guidelines for PAD Testing
- 2016 AHA-ACC Guidelines-Executive Summary – View or Share
- 2016 AHA-ACC Guidelines-Full Version – View or Share
Additional simpleABI Vascular Reimbursement Information
Vascular studies are diagnostic procedures performed to determine blood flow and/or the condition of arteries and/or veins. Vascular studies include patient care required to perform the studies, supervision of the studies and interpretation of the study results with copies for patient records of hard copy output with analysis of all data. Non-invasive testing for peripheral artery disease (PAD) does not have “National Coverage Determinations”. Instead, individual Medicare insurance carriers determine the local coverage requirements.
2023 Criteria for PAD Testing
Summary: Effective January 1, 2011, CMS made changes to the most common CPT codes used for lower extremity testing which mirrored the periodic statement from the American Heart Association and American College of Cardiology (AHA/ACC). In addition to 2011, the AHA/ACC reconfirmed their clinical recommendations in 2016 and again in 2019. These changes to CPT descriptions provided specific examples of testing methods within the CPT codes themselves. It is important to differentiate between AHA/ACC clinical recommendations and reimbursement criteria. Given that CPT codes 93922-93924 apply to both upper and lower extremity diagnostic testing, the specific protocols are cited as examples and not requirements for reimbursement.
2011/2016/2019 AHA/ACC RECOMMENDATIONS VS CPT CODES
In 2011 CMS significantly changed the description for reimbursement under CPT 93922, CPT 93923, & CPT 93924. Previously only an ABI (with no mention of how the pressures were acquired) and waveforms from a bidirectional Doppler or a pulse volume recording (PVR) were required. Currently there are specific examples cited stating the ABI pressures must be measured using both the posterior tibial (PT) and the dorsalis pedis (DP) arteries. These examples follow e.g., Latin for exempli gratia or translated for example. These CPT codes also cover upper extremity testing where certainly dual ankle pressures are not required or clinically appropriate. The reconfirmed AHA/ACC guidelines are still straightforward and using dual ankle pressures are clinically useful to separate and localize blood flow in two significant arteries in the legs. While the ACC/AHA continues to recommend using a Doppler based device and measuring pressures as the ‘gold standard’ for ABI diagnosis, there are also clinical reasons for performing vascular diagnosis with alternative methods.