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12437 Results

Transcranial Doppler Studies

Service Code
93886 (CPT) Transcranial Doppler study of the intracranial arteries; complete study
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93888 (CPT) Transcranial Doppler study of the intracranial arteries; limited study
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Exclusions

Note: CPT codes 93888, 93892, and 93893 are included in 93886. They are not separately reimbursable on the same date of service, same or different provider, and same type of service

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93892 (CPT) Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Exclusions

Note: CPT codes 93888, 93892, and 93893 are included in 93886. They are not separately reimbursable on the same date of service, same or different provider, and same type of service

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93893 (CPT) Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Exclusions

Note: CPT codes 93888, 93892, and 93893 are included in 93886. They are not separately reimbursable on the same date of service, same or different provider, and same type of service

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93896 (CPT) Vasoreactivity study performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93897 (CPT) Emboli detection without intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

Transcranial Doppler Studies

Service Code
93898 (CPT) Venous-arterial shunt detection with intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Transcranial Doppler (TCD) is used for the noninvasive assessment of blood flow to the brain. The noninvasive test uses sound waves to determine the blood flow moving through the arteries to the brain. The study can assist in determining if the arteries are narrowed or blocked. A transducer (probe) placed at the neck or the temple sends an ultrasound signal. The signal is received and transmitted to a microcomputer that calculates how fast the blood is traveling through the artery. A complete TCD study may include assessment of anterior (front) or posterior (back) cerebrovascular circulation. Complete cerebrovascular ultrasound could include both carotid duplex and TCD.

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Limits

TCD studies are limited to one procedure per date of service by the same or different provider.

  • a. Technical or professional components of TCD studies cannot to be billed on the same

date of service by the same or different provider as the complete procedure.

  • b. TCD studies are included in the reimbursement for surgery. Therefore, it is cannot be

billed separately when performed during a surgical session

Place of Service

Inpatient, Outpatient, Office, Home, Skilled nursing facility, Intermediate care facility and Independent Diagnostic Testing Facility (IDTF).

How to Submit

N/A - No authorization is required

Resources

93970 DUPLEX SCAN OF EXTREMITY VEINS; COMPLETE, BILATERA

Service Code
93970 (CPT) 93970 DUPLEX SCAN OF EXTREMITY VEINS; COMPLETE, BILATERA
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Unlisted noninvasive vascular diagnostic study

Service Code
93998 (CPT) Unlisted noninvasive vascular diagnostic study
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Evolent. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Evolent. If your request is for INPATIENT services, please submit the request to Trillium.

Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan

Service Code
94005 (CPT) Home ventilator management care plan oversight of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living) requiring review of status, review of laboratories and other studies and revision of orders and respiratory care plan
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation

Service Code
94010 (CPT) Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration

Service Code
94060 (CPT) Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Vital capacity, total (separate procedure)

Service Code
94150 (CPT) Vital capacity, total (separate procedure)
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Maximum breathing capacity, maximal voluntary ventilation

Service Code
94200 (CPT) Maximum breathing capacity, maximal voluntary ventilation
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Respiratory flow volume loop

Service Code
94375 (CPT) Respiratory flow volume loop
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

94640 PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION

Service Code
94640 (CPT) 94640 PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required

Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device

Service Code
94664 (CPT) Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation

Service Code
94667 (CPT) Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent

Service Code
94668 (CPT) Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Age Group
All
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

Please submit your request to Trillium Health Resources

94729 DIFFUSING CAPACITY (EG, CARBON MONOXIDE, MEMBRANE) (LIST SEPARATELY IN ADDITION

Service Code
94729 (CPT) 94729 DIFFUSING CAPACITY (EG, CARBON MONOXIDE, MEMBRANE) (LIST SEPARATELY IN ADDITION
Prior Authorization Required
No
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

How to Submit

N/A - No authorization is required