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Stress Test for Medicare patient

Michelle Posted Tue 21st of October, 2014 13:17:58 PM

Is there any limit as to how many stress tests a medicare patient can have in a 12 month period? I did not find anything on the CMS website addressing this issue.

SuperCoder Answered Wed 22nd of October, 2014 11:35:07 AM

Thanks for your question. There appears to be no specific guidance on frequency guidelines for cardiac stress tests. What the Centers for Medicare and Medicaid Services (CMS) does make clear is that cardiac stress tests are reviewed by Medicare on a case by case basis. There are certain diagnoses that are reimbursed by Medicare. Your provider’s documentation should support the medical necessity for the patient receiving the service. The provider should determine the frequency need of the test based on the patient’s condition. Your claim may be brought for review, so make sure that your documentation reflects the need for the frequency of the services and that it supports medical necessity. Attached are a couple of links that further explain Medicare's stance on the stress test. Hope this helps.

http://downloads.cms.gov/medicare-coverage-database/lcd_attachments/28565_28/l28565_cv026_cbg_10012010.pdf

http://www.medicarepaymentandreimbursement.com/2011/07/cardiovascular-stress-testing-cpt-93015.html

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