Myocardial Strain Imaging
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This policy governs coverage and coding for myocardial strain imaging (including speckle-tracking echocardiography and MRI-based strain) for members of Blue Cross Blue Shield - Rhode Island Medicare Advantage and Commercial plans.
No material clinical or coverage changes in this revision.
Coverage decision rules
Exposure to cardiotoxic medications or radiation
Supported by observational studies and the SUCCOUR randomized trial which showed increased cardioprotective therapy use but no difference in primary LVEF endpoint at 1 year; long-term clinical benefit remains unproven.
All other indications
Potential applications include coronary artery disease, valvular disease, cardiomyopathies, and stress cardiomyopathy, but clinical outcome benefit is not established.
This policy addresses coverage for myocardial strain imaging for members of Blue Cross Blue Shield - Rhode Island Medicare Advantage and Commercial plans. Myocardial strain imaging is not covered for Medicare Advantage Plans and is regarded as not medically necessary for Commercial Products when used in individuals with exposure to medications or radiation that could cause cardiotoxicity, because the evidence does not demonstrate improvement in net health outcomes. The policy likewise states that myocardial strain imaging is not covered for Medicare Advantage Plans and not medically necessary for Commercial Products for all other indications for the same reason.
The policy explicitly identifies the procedure and billing codes considered not covered or not medically necessary: CPT 93356 (Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics), and HCPCS codes C9762 and C9763 (cardiac magnetic resonance imaging with strain imaging and with stress imaging, respectively). These codes are listed as not covered for Medicare Advantage Plans and not medically necessary for Commercial Products.
Billing codes and coverage status
| 93356 | Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging) |
Provider responsibilities and billing impact
Prior authorization not applicable — verify benefits; listed codes may be denied
Prior authorization is not applicable for myocardial strain imaging; however, benefits and coverage may vary by contract and services billed with codes 93356, C9762, and C9763 may be denied as not medically necessary.
No step therapy specified; evidence insufficient
No step therapy requirements are specified in this policy; clinical evidence is described as insufficient to demonstrate improved net health outcome, and myocardial strain imaging use remains considered not covered/not medically necessary in the situations described.
- Policy states evidence is insufficient to show improved net health outcome (SUCCOUR RCT and other studies).
- Use for cardiotoxicity monitoring and other indications is considered not covered/not medically necessary.
Verify benefits in Evidence of Coverage / Subscriber Agreement
Confirm member-specific coverage by reviewing the member's Evidence of Coverage or Subscriber Agreement because benefits may vary between groups/contracts and some uses are listed as not covered or not medically necessary.
- Refer to Evidence of Coverage or Subscriber Agreement for applicable not medically necessary/not covered benefits.
- Coverage determinations may differ for Medicare Advantage versus Commercial plans.
Clinical background
Myocardial strain refers to quantifying myocardial deformation — the shortening, lengthening, or thickening of cardiac muscle during the cardiac cycle. It is most commonly assessed as global longitudinal strain, a percentage measure of left ventricular deformation in the long axis, and is frequently measured using speckle-tracking echocardiography, which analyzes natural acoustic markers in 2D echocardiographic images with dedicated software. Strain imaging can detect subclinical left ventricular dysfunction earlier than ejection fraction and has been investigated for applications such as monitoring for chemotherapy- or radiation-related cardiotoxicity and evaluation of various cardiomyopathies; however, current evidence is insufficient to demonstrate that routine use of strain-guided management improves clinical outcomes.
Key terms and definitions
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