What types of cardiovascular procedures require prior authorization?

  • The procedures requiring clinical certification generally include the following:*
  • Advanced Imaging and Diagnostic Services:
  • - Stress testing
    - Myocardial perfusion imaging (SPECT and PET)
    - Stress echocardiography
    - Echocardiography: transthoracic and transesophageal
    - Diagnostic heart catheterization
    - Cardiac CT and MRI
  • Implantable Device Services:
  • - Pacemakers
    - Implantable cardioverter defibrillator (ICD)

*The requirements for clinical certification of specific procedures can vary by health plan.

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