DraftBlue Cross Blue Shield - Rhode IslandPolicy N/A

Myocardial Strain Imaging

This policy governs coverage determinations for myocardial strain imaging (speckle-tracking echocardiography, tissue Doppler, and CMR strain) for Medicare Advantage and Commercial products offered by Blue Cross Blue Shield - Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMyocardial Strain Imaging (coverage: not covered for Medicare Advantage; not medically necessary for Commercial)

Policy CodePolicy N/A

Change TypeRoutine review — no material change

Effective DateJul 1, 202616d

Next Review DateApr 3, 2026

Key ActionVerify member benefits and eligibility against the Evidence of Coverage or Subscriber Agreement; document medical necessity if applicable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

93356, C9762, C9763Procedure/Codes listed

Evidence insufficientRationale

Medicare & CommercialProducts

FDA 510(k)Regulatory example

Coverage Determinations

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Not covered — Medicare Advantage Plans

Coverage determinations for myocardial strain imaging

Medicare Advantage Plans: Myocardial strain imaging (including speckle-tracking echocardiography and CMR strain codes listed) is considered not covered for Medicare Advantage Plans because the evidence is insufficient to demonstrate improvement in net health outcome.

Supported by policy statement that evidence is insufficient

Not medically necessary — Commercial Products

Coverage for Commercial Products

Commercial Products: Myocardial strain imaging is considered not medically necessary for Commercial Products in all situations, including for individuals with exposure to cardiotoxic medications or radiation, as evidence is insufficient to show improved net health outcome.

Policy explicitly states NMN for commercial plans

Benefits and covered services may vary between employer groups, contracts, and plan designs. Refer to the member’s Evidence of Coverage or Subscriber Agreement to determine whether myocardial strain imaging is a covered benefit for a specific subscriber before scheduling or billing services.

Myocardial strain imaging (including speckle-tracking echocardiography and cardiac MRI strain techniques) is designated as not covered for Medicare Advantage Plans and not medically necessary for Commercial Products. The policy rationale is that the available evidence is insufficient to demonstrate an improvement in net health outcome, and this applies both to individuals exposed to potentially cardiotoxic medications or radiation and to all other clinical situations described in the policy. As a result, claims for the listed procedure codes are at risk for denial under these product types.

Billing and Coding

Not covered / Not medically necessaryCPTNot Covered

93356

Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging)

Not covered / Not medically necessary (HCPCS G-type/C-codes listed)HCPCSNot Covered

C9762	Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging
C9763	Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging

Provider Requirements and Billing Risks

Prior Authorization

Prior authorization is not required for myocardial strain imaging. Verify member benefits and coverage specifics in the Evidence of Coverage or Subscriber Agreement prior to performing services.

Denial Risk

Claims Subject to Denial

The following CPT/HCPCS codes are considered not covered for Medicare Advantage Plans and are not medically necessary for Commercial Products. Claims submitted with these codes may be denied.

CPT 93356 — Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging)
HCPCS C9762 — Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with strain imaging
HCPCS C9763 — Cardiac magnetic resonance imaging for morphology and function, quantification of segmental dysfunction; with stress imaging

Background

Myocardial strain quantifies myocardial deformation (shortening, lengthening, or thickening) through the cardiac cycle and can be measured using several techniques, including tissue Doppler imaging, speckle-tracking echocardiography, and cardiac magnetic resonance (CMR) strain. Global longitudinal strain is a commonly reported parameter that measures left ventricular deformation along the long axis and can detect subclinical left ventricular dysfunction, sometimes earlier than ejection fraction. Proposed clinical uses include evaluation in coronary artery disease, cardiomyopathies, valvular disease, stress cardiomyopathy, and surveillance for chemotherapy- or radiation-related cardiotoxicity. However, despite these potential applications, the policy finds the evidence insufficient to show that routine use of strain imaging improves net health outcomes.

Key Definitions

Global longitudinal strain — definition and clinical relevance

DefinitionGlobal longitudinal strain (GLS) is the quantitative measure of left ventricular deformation in the long axis, expressed as a percentage representing myocardial shortening during systole.

Clinical useUsed to assess global left ventricular function and to provide segmental quantitative myocardial deformation analysis, potentially detecting subclinical systolic dysfunction before changes in ejection fraction.

PhysiologyDuring systole, ventricular myocardial fibers shorten with movement from base to apex; GLS captures this longitudinal shortening across the cardiac cycle.

ApplicationsProposed applications include coronary artery disease, ischemic and dilated cardiomyopathies, valvular disease, hypertrophic cardiomyopathies, stress cardiomyopathy, and chemotherapy-related cardiotoxicity.

Interpretation noteGLS is reported as a percentage for each left ventricle segment and as a global value; reductions in GLS may indicate subclinical impairment even when ejection fraction is preserved.

Speckle-tracking echocardiography — definition

DefinitionSpeckle-tracking echocardiography is an imaging technique that uses software to track natural acoustic markers (speckles) on routine 2-dimensional echocardiography frames to calculate myocardial displacement and deformation.

MethodSpeckles are stable interference patterns created by interaction of the ultrasound beam with myocardial fibers; image-processing algorithms identify and track similar patterns frame-to-frame to measure spatiotemporal displacement.

AnalysisEchocardiograms are processed with dedicated acoustic-tracking software (often offline, semiautomated) on workstations to derive strain measures including global longitudinal strain and rotational/torsional dynamics.

Clinical advantageMore widely used than tissue Doppler because it is less angle-dependent and provides detailed 2-dimensional displacement data for myocardial deformation assessment.