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    v1.0.31
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyEvolent Doppler Claim Edit Coverage | OpenPayer
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    CurrentEvolentPolicy OP.388.01

    Cardiac Claim Edit - Stress Echo and Doppler Add-On

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    This policy governs Evolent claim edits for Doppler add-on codes billed with stress echocardiography, transthoracic echocardiography, or transesophageal echocardiography. It applies to provider claim submissions reviewed by Evolent affiliates and subsidiaries across Commercial, Medicaid, and Medicare Advantage products.

    Policy Summary
    PayerEvolent
    PolicyCardiac Claim Edit - Stress Echo and Doppler Add-On
    Policy CodePolicy OP.388.01
    Change TypeNew Policy
    Effective DateJan 11, 2020
    Last ReviewDec 6, 2019
    Next Review DateN/A
    Key ActionEnsure stress echocardiography is authorized; otherwise, the related Doppler add-on is not paid.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3Doppler add-on codes addressed
    3Stress echocardiography codes addressed
    12TTE/TEE codes compatible with Doppler
    Same date

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Timing condition for stress echocardiography and Doppler without TTE or TEE
    Not necessaryRoutine Doppler without clinical indication

    Stress Echocardiography and Doppler Payment Criteria

    Stress Echocardiography and Doppler Payment Criteria

    Apply the following claim-edit logic to determine payment for stress echocardiography (SE), transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and Doppler services.

    ONE of the following payment scenarios

    • SE and Doppler billed on the same date of service without TTE or TEE

      • The SE is authorized.

      • ONE diagnosis condition

        • An approved clinical-condition diagnosis code is reported on either the SE claim line or the Doppler claim line.

          Payment is allowed for both the SE and Doppler.

        • The claim diagnosis is not for an approved clinical condition.

          Payment is allowed for the SE only; the Doppler is not paid.

    • Doppler billed with TTE or TEE

      • The associated TTE or TEE is authorized.

        Payment for the Doppler is allowed.

    • Authorization failure

      • The SE is not authorized.

        Payment for a related Doppler is not allowed.

      • The TTE or TEE is not authorized.

        Payment for a related Doppler is not allowed.

    Applicable Procedure Codes

    Doppler add-on codesCPT
    93320Doppler add-on code
    93321Doppler add-on code
    93325Doppler add-on code
    TTE and TEE echocardiography codes compatible with DopplerCPT
    93303Echocardiography TTE/TEE code
    93304Echocardiography TTE/TEE code
    93306Echocardiography TTE/TEE code
    93307Echocardiography TTE/TEE code
    93308Echocardiography TTE/TEE code
    93312Echocardiography TTE/TEE code
    93313Echocardiography TTE/TEE code
    93314Echocardiography TTE/TEE code
    93315Echocardiography TTE/TEE code
    93316Echocardiography TTE/TEE code
    1–10 of 12
    1/2
    Stress echocardiography codesCPT
    93350Stress echocardiography code
    93351Stress echocardiography code
    93352Stress echocardiography code

    Authorization, Diagnosis, and Payment Requirements

    Prior Authorization

    Authorization Required for Related Doppler Payment

    Obtain authorization for the applicable stress echocardiography (SE) or echocardiography service before billing the related Doppler. If the SE or TTE/TEE is not authorized, the related Doppler will not be paid.

    Billing Rule

    Doppler Allowed with Authorized TTE or TEE

    Payment for a Doppler is allowed when it is billed with an authorized transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE).

    Unsupported block type: documentation

    Billing Rule
    Policy Summary
    PayerEvolent
    PolicyCardiac Claim Edit - Stress Echo and Doppler Add-On
    Policy CodePolicy OP.388.01
    Change TypeNew Policy
    Effective DateJan 11, 2020
    Last ReviewDec 6, 2019
    Next Review DateN/A
    Key ActionEnsure stress echocardiography is authorized; otherwise, the related Doppler add-on is not paid.
    SourceLink
    On This Page
    Stress Echocardiography and Doppler Payment CriteriaApplicable Procedure CodesAuthorization, Diagnosis, and Payment Requirements

    Approved Diagnosis Supports Payment of Both Services

    If either the SE or Doppler claim line includes a diagnosis code for an approved clinical condition, payment is allowed for both the SE and Doppler when the SE has been authorized.

    Denial Risk

    Non-Approved Diagnosis Creates Doppler Denial Risk

    If the diagnosis code on the claim is not for an approved clinical condition, the authorized SE may be paid, but the Doppler will be denied.