CurrentColorado Rocky Mountain Health PlansPolicy N/A

UnitedHealthcare Medicare Advantage cardiology prior authorization CPT code list and crosswalks

Governance of CPT codes and crosswalks used to request prior authorization for cardiology services under UnitedHealthcare Medicare Advantage plans; intended for providers submitting prior authorization requests and claims reviewers.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyUnitedHealthcare Medicare Advantage cardiology prior authorization CPT code list and crosswalks

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit prior authorization requests via the UnitedHealthcare Provider Portal (UHCprovider.com) or call 866-889-8054; authorization numbers are valid for 45 calendar days.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

93452-93461Diagnostic catheterization CPT codes covered in crosswalk

33206-33270Electrophysiology and pacemaker/ICD implant codes listed

93350-93351Stress echocardiography CPT codes crosswalked

45Prior authorization number validity period (days)

Prior Authorization and Claim Substitution Rules

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Prior authorization and claim substitution criteria

Crosswalk-based claim requirements and substitution rules for prior authorization

ALL of the following

Examples (per crosswalk table)
- 93452: claims must include one of these CPT codes: 93453-93461.
- 93453: claims must include one of these CPT codes: 93452; 93454-93461.
- 93454: claims must include one of these CPT codes: 93452-93453; 93455-93461.
- 93455: claims must include one of these CPT codes: 93452-93454; 93456-93461.
- 93456: claims must include one of these CPT codes: 93452-93455; 93457-93461.
- 93457: claims must include one of these CPT codes: 93452-93456; 93458-93461.
- 93458: claims must include one of these CPT codes: 93452-93457; 93459-93461.
- 93459: claims must include one of these CPT codes: 93452-93458; 93460-93461.
- 93460: claims must include one of these CPT codes: 93452-93459; 93461.
- 93461: claims must include one of these CPT codes: 93452-93460.

For stress echocardiography, CPT codes 93350 and 93351 are interchangeable for claims and prior authorization; a claim billed with 93350 should be accepted as 93351 and vice versa.

There are no substitute CPT codes for electrophysiology implant procedures; crosswalk substitution does not apply to electrophysiology implant codes.

CPT Code Lists and Crosswalks

Electrophysiology implant and pacemaker/ICD codesCPT

33206	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial
33207	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
33208	Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
33270	Insertion or replacement of permanent subcutaneous implantable defibrillator system

Diagnostic catheterization codesCPT

93452	Left heart catheterization, including intraprocedural injection(s) for left ventriculography
93454	Catheter placement in coronary artery(s) for coronary angiography
93458	Catheter placement in coronary artery(s) for coronary angiography; with left heart catheterization
93461	Catheter placement in coronary artery(s) for coronary angiography; with right and left heart catheterization and bypass graft angiography

Stress echocardiography codesCPT

93350	Echocardiography, transthoracic, real-time with image documentation during rest and cardiovascular stress test
93351	Echocardiography, transthoracic, during rest and stress test; includes continuous ECG monitoring

inv-05: Crosswalk substitution requirement

RequirementFor each diagnostic catheterization CPT code (93452–93461), claims must include one of the interchangeable CPT codes listed in the crosswalk table for that specific code.

Example - 93452Claims for 93452 must include one of: 93453–93461.

Example - 93458Claims for 93458 must include one of: 93452–93457; 93459–93461.

Example - 93461Claims for 93461 must include one of: 93452–93460.

Submission, Validity, and Substitution Guidance

Prior Authorization

Prior Authorization Submission and Validity

Providers may submit prior authorization requests for cardiology CPT codes via the UnitedHealthcare Provider Portal (UHCprovider.com) or by phone. When a prior authorization request is issued, the assigned authorization number is valid for 45 calendar days from the date of issue.

Submit via UnitedHealthcare Provider Portal (UHCprovider.com) or call 866-889-8054
Prior authorization number is valid for 45 calendar days

Billing Rule

CPT Code Substitution Guidance

The following crosswalks list CPT codes that are interchangeable for prior authorization. Substitution is appropriate when the requested procedure corresponds to one of the mapped codes. Note: there are no substitute CPT codes for electrophysiology implant procedures.

Diagnostic catheterization: 93461 corresponds to and requires claims to include one of CPT codes 93452-93460
Stress echocardiogram: 93350 and 93351 are interchangeable for claims (93350 ⇄ 93351)

Definitions and Interchangeability Notes

inv-08: Interchangeable CPT code table

Interchangeable diagnostic catheterization codes93452 ⇄ 93453–93461 (claims for 93452 must include one of 93453–93461).

Diagnostic crosswalk examples93454 ⇄ 93452–93453; 93455–93461; 93456 ⇄ 93452–93455; 93457 ⇄ 93452–93456; 93458 ⇄ 93452–93457; 93459 ⇄ 93452–93458; 93460 ⇄ 93452–93459; 93461 ⇄ 93452–93460.

Interchangeable stress echocardiography codes93350 ⇄ 93351 (claims for 93350 may be substituted with 93351 and vice versa).

inv-09: Electrophysiology implant procedures

Electrophysiology implant proceduresThere are no substitute CPT codes for electrophysiology implant procedures; crosswalk substitution does not apply to these codes.

Implication for claimsDo not substitute or rely on crosswalk mappings for pacemaker/ICD implant CPT codes when submitting claims or prior authorization requests.

Source noteStatement included in the diagnostic catheterization crosswalk section noting absence of substitutes for EP implant procedures.