Transcranial Doppler Studies
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Coverage policy governing when transcranial Doppler (TCD) studies of intracranial arteries are covered or not covered for North Carolina Medicaid beneficiaries, including EPSDT considerations for beneficiaries under 21.
Prior approval removed from Medicaid and NCHC for transcranial Doppler Studies.
CPT 2025 update adding CPT codes +93896, +93897, +93898 and deleting 93890 effective 01/01/2025.
Coverage Criteria for Transcranial Doppler (TCD) Studies
Specific Criteria Covered
Covered when ANY of the following specific clinical indications are present:
These are the specific covered indications listed in the policy.
General Criteria Covered
Covered when ALL of the following general medical necessity criteria are met:
Standard general coverage criteria.
Coverage with criteria
Covered when ALL general coverage and billing rules are met and limits observed
Derived from general not-covered criteria which define inverse of coverage
See Limitations or Requirements (Section 5.3).
Medicaid does not cover the procedure, product, or service when it duplicates another provider's procedure, product, or service, or when it is experimental, investigational, or part of a clinical trial. These exclusions apply in addition to failure to meet eligibility or policy criteria (see Section 2.0 and Section 3.0).
When evaluating claims, verify that the requested service is not a repeat of care already furnished by another provider and is not being provided as part of a research protocol; if either condition is present, the service is non-covered under this policy.
Services are excluded when the beneficiary does not meet the eligibility requirements in Section 2.0, or does not meet the clinical criteria in Section 3.0. Additionally, Medicaid does not cover services that duplicate another provider's service or are experimental, investigational, or part of a clinical trial.
The policy lists no additional specific Medicaid-only non-covered items beyond these general exclusions.
CPT codes 93888, 93892, and 93893 are included in CPT 93886 and are not separately reimbursable on the same date of service, same or different provider, and same type of service. Providers must report the most specific CPT/HCPCS code describing the service and follow unlisted procedure reporting requirements when applicable.
Services are not covered when the beneficiary fails to meet the eligibility criteria in Section 2.0 or the coverage criteria in Section 3.0. Claims submitted under these circumstances may be denied.
Ensure documentation supports medical necessity and that the requested TCD study aligns with the policy criteria before billing to avoid denials.
A service is considered not medically necessary where it duplicates another provider's service or where the beneficiary does not meet the policy's stated eligibility or clinical criteria. Such services will not be covered by Medicaid under this policy.
Coding — CPT and ICD-10 Guidance
| D57.00 - D57.02 | Listed ICD-10-CM ranges paired with cerebrovascular codes |
| D57.01 | Listed ICD-10-CM with paired I63.x codes |
| D57.04 | Listed ICD-10-CM with paired I63.x codes |
| D57.1 | Listed ICD-10-CM with paired I63.x codes |
| D57.20 - D57.219 | Listed ICD-10-CM with paired I63.x/I65.x codes |
| D57.211 | Listed ICD-10-CM with paired I63.x codes |
| D57.212 | Listed ICD-10-CM with paired I63.x and I65.x codes |
| D57.214 | Listed ICD-10-CM with paired I63.212 and I65.02 |
| D57.3 | Listed ICD-10-CM with paired I63.22/I65.03 |
| D57.414 | Listed ICD-10-CM with paired I63.231 - I63.239 |
| D57.00 - D57.02 | ICD-10 mapping entries listed in document |
| D57.01 | ICD-10 mapping entries listed in document |
| D57.04 | ICD-10 mapping entries listed in document |
| D57.1 | ICD-10 mapping entries listed in document |
| D57.20 - D57.219 | ICD-10 mapping entries listed in document |
| D57.211 | ICD-10 mapping entries listed in document |
| D57.212 | ICD-10 mapping entries listed in document |
| D57.214 | ICD-10 mapping entries listed in document |
| D57.3 | ICD-10 mapping entries listed in document |
| D57.414 | ICD-10 mapping entries listed in document |
Provider Actions, Billing, and Documentation Requirements
Prior Approval Requirement
If the service requires prior approval, providers must follow NCTracks prior approval processes. For beneficiaries under 21, EPSDT does not waive any prior approval requirement — prior approval is still required when specified by the service policy or NCTracks guidance. See NCTracks Provider Claims and Billing Assistance Guide and the NC Medicaid EPSDT provider page for details.
- Prior approval remains required when the policy or NCTracks indicates, even for beneficiaries under 21.
- Refer to NCTracks Provider Claims and Billing Assistance Guide: https://www.nctracks.nc.gov/content/public/providers/provider-manuals.html
- EPSDT provider information: https://medicaid.ncdhhs.gov/
Prior approval not required
Medicaid does not require prior approval for Transcranial Doppler Studies.
- Transcranial Doppler Studies — no prior approval required for Medicaid.
Required CPT reporting and bundling note
Report CPT/HCPCS codes at the most specific level that accurately and completely describe the service. CPT codes 93888, 93892, and 93893 are considered included in 93886 and are not separately reimbursable on the same date of service, whether billed by the same or different provider and for the same type of service. Use appropriate modifier and billing guidance from NCTracks when billing add-on codes (+93896, +93897, +93898).
- Included codes: CPT 93888, 93892, 93893 are included in 93886 and are not separately payable when rendered the same date/same service.
- New add-on codes effective 01/01/2025: +93896, +93897, +93898 (see fee schedule and NCTracks billing guidance).
- Follow NCTracks and payer rules for correct modifier use and facility/provider billing distinctions.
Eligibility and EPSDT Documentation
Providers must verify Medicaid eligibility at each encounter. For beneficiaries under 21, document how the requested service meets EPSDT medical necessity standards — showing the service corrects or ameliorates a defect, illness, or condition, is the most appropriate/effective treatment available, and why limitations in clinical coverage should be exceeded if applicable.
- Verify Medicaid eligibility for every service date.
- For beneficiaries <21, include EPSDT justification in the medical record when services exceed standard limits or when requesting exceptions.
Claims and coding documentation
Providers shall comply with NCTracks Provider Claims and Billing Assistance Guide, Medicaid bulletins, fee schedules, and NC Medicaid clinical coverage policies for billing and reimbursement rules. Report ICD-10-CM and PCS codes to the highest level of specificity that supports medical necessity and use the current code editions in effect at the time of service.
- Follow NCTracks Provider Claims and Billing Assistance Guide and Medicaid bulletins for claim submission rules.
- Report ICD-10-CM and PCS codes to the highest level of specificity supporting medical necessity.
- Use current CPT/HCPCS/UB-04 manuals and editions effective at time of service.
Coding specificity and unlisted procedure documentation
Report the most specific CPT/HCPCS code that accurately and completely describes the procedure. If no specific code exists, use the appropriate unlisted procedure code and include the required special report per CPT/HCPCS instructions.
- Use current CPT and HCPCS instructions for unlisted procedure reporting and include required special reports.
- Ensure coding supports medical necessity in the clinical documentation.
Conservative Therapy Requirement
The service must be individualized, necessary, and no equally effective, more conservative, or less costly statewide treatment should be available. Document attempts at and/or reasons why conservative therapies are not appropriate or effective for this beneficiary when applicable.
- Procedure must be individualized, specific, and consistent with diagnosis.
- Document that no equally effective, more conservative, or less costly statewide treatment is available.
Step therapy
No step therapy requirements apply to this service.
- No general or specific step therapy requirements.
Triggers for Denial
Claims may be denied when eligibility or coverage criteria are not met, the service duplicates another provider's service, the service is experimental/investigational, or documentation does not support medical necessity. Ensure medical records, coding, and prior authorization (when required) support the billed service.
- Denial triggers include: beneficiary not meeting Section 2.0 eligibility, not meeting Section 3.0 coverage criteria, duplicate services, or experimental/investigational services.
- Insufficient documentation of medical necessity, incorrect or non-specific coding, or failure to follow NCTracks billing rules may result in claim denial.
Background
Transcranial Doppler (TCD) is a noninvasive ultrasound technique used to assess intracranial blood flow and detect arterial narrowing or occlusion. A transducer is applied at skull windows to measure blood flow velocity in the anterior and/or posterior cerebrovascular circulation.
TCD may be performed alongside carotid duplex as part of cerebrovascular ultrasound studies and is intended to provide hemodynamic information about intracranial arteries rather than direct visualization of vessel walls.
Definitions
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