What types of cardiovascular procedures require prior authorization?
The procedures requiring clinical certification generally include the following:*
- Stress testing
- Myocardial perfusion imaging (SPECT & PET)
- Stress echocardiography
- Cardiac CT and MRI
- Echocardiography
- Transthoracic (TTE)
- Transesophageal (TEE)
- Diagnostic heart catheterization
- Pacemakers
- Implantable cardioverter defibrillator (ICD)
- Vascular interventions
- Percutaneous coronary intervention
*The requirements for clinical certification of specific procedures can vary by health plan. In some instances, covered procedures may be reviewed through a claims-based post-service process.