Strain Imaging (Myocardial Strain Imaging)
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Defines coverage stance for myocardial strain imaging (echocardiographic speckle-tracking and MRI strain) for Blue Cross Blue Shield - Rhode Island Medicare Advantage and Commercial products.
No material clinical or coverage changes in this revision.
Coverage Criteria for Myocardial Strain Imaging
Medicare Advantage - Not Covered
Rationale: evidence insufficient to show improvement in net health outcome (see clinical evidence).
Commercial Products - Not Medically Necessary
Rationale: evidence insufficient to demonstrate improvement in net health outcome.
This policy does not identify any clinical situations in which myocardial strain imaging is covered. For both Medicare Advantage and Commercial products, myocardial strain imaging is expressly considered not covered (Medicare Advantage) or not medically necessary (Commercial) in all circumstances. The policy specifies that this includes individuals with exposure to cardiotoxic medications or radiation as well as all other clinical scenarios because the evidence is insufficient to demonstrate improvement in net health outcomes.
For Commercial products the policy explicitly designates myocardial strain imaging procedures as not medically necessary. This includes the echocardiographic procedure reported with CPT 93356 (myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics) and the HCPCS codes C9762 and C9763 for cardiac MRI with strain or stress imaging. Claims submitted with these codes are therefore considered not payable under the stated Commercial coverage stance, consistent with the policy rationale that available evidence is insufficient to show improved net health outcomes.
Coding — Affected Procedure Codes
| 93356 | Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging) |
Provider Actions and Billing Guidance
No step therapy requirements
No step therapy requirements are specified in this policy.
Verify benefits and eligibility before billing
Verify member-specific benefits and eligibility before billing by checking the Evidence of Coverage/Subscriber Agreement and contacting the provider call center for member-specific benefits.
- Benefits may vary by group/contract; the Evidence of Coverage or Subscriber Agreement supersedes this policy.
- Call the provider call center for member-specific benefit information.
Background on Myocardial Strain Imaging
Myocardial strain quantifies myocardial deformation during the cardiac cycle and reflects changes in myocardial length and thickening. Common assessment methods include tissue Doppler, speckle-tracking echocardiography, and cardiac magnetic resonance imaging. Global longitudinal strain—most commonly obtained by speckle-tracking echocardiography—measures longitudinal shortening of the left ventricle during systole and is expressed as a percentage. Although strain techniques can detect subclinical left ventricular dysfunction earlier than conventional measures and have proposed applications such as monitoring for cardiotoxicity, the policy concludes that current evidence is insufficient to establish that strain-guided management improves net health outcomes, which underlies the noncoverage and not medically necessary determinations.
Definitions
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