CurrentKaiser PermanentePolicy N/A

Clinical Review Criteria — Myocardial Strain Imaging (Speckle‑tracking echocardiography)

Clinical review criteria governing medical necessity determinations for myocardial strain imaging (speckle-tracking echocardiography) for Kaiser Foundation Health Plan of Washington members and their providers.

Policy Summary

PayerKaiser Permanente

PolicyMyocardial Strain Imaging (Speckle‑tracking echocardiography) — Clinical Review Criteria

Policy CodePolicy N/A

Change TypeMaintenance review, no material changes

Effective DateJul 1, 2022

Next Review DateApr 7, 2026

Key ActionInclude the last 6 months of clinical notes from the requesting provider and/or specialist when submitting requests to support medical necessity.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1Not Medically Necessary CPTs

CoveredOncology‑related coverage

ExperimentalOther indications

No NCD/LCDMedicare guidance

Coverage Criteria

Policy Summary

PayerKaiser Permanente

PolicyMyocardial Strain Imaging (Speckle‑tracking echocardiography) — Clinical Review Criteria

Policy CodePolicy N/A

Change TypeMaintenance review, no material changes

Effective DateJul 1, 2022

Next Review DateApr 7, 2026

Key ActionInclude the last 6 months of clinical notes from the requesting provider and/or specialist when submitting requests to support medical necessity.

SourceLink

On This Page

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Myocardial strain imaging (MSI) is considered experimental, investigational or unproven for all indications other than monitoring for cardiotoxicity related to oncology medications. The policy explicitly limits coverage to use prior to, during, or following exposure to oncology agents that can cause cardiotoxicity (for Non‑Medicare members); all other clinical uses are not established by the evidence in this policy and are therefore treated as investigational.

Provider Actions / Billing Guidance

Denial Risk

Denial Risk — CPT 93356

CPT 93356 (Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics) is considered Not Medically Necessary and may be denied if billed.

Affected code: CPT 93356

Prior Authorization

Prior Authorization / Code-specific Requirement

Verify pre-authorization requirements for the specific plan using the payer's Pre-authorization Code Check prior to scheduling or billing.

Documentation Required

Required Supporting Documentation

Requests must include supporting clinical documentation to substantiate medical necessity. Include the last 6 months of clinical notes from the requesting provider and/or specialist with the request.

Documentation required: Last 6 months of clinical notes from requesting provider and/or specialist

Billing Rule

Provider Billing Implication

Providers should be aware that CPT 93356 is listed as Not Medically Necessary; submission of prior authorization does not guarantee payment and claims may be denied.

Background

Myocardial strain imaging (MSI) uses speckle-tracking analysis of echocardiographic images to quantify myocardial deformation and mechanics. Specialized image‑processing software tracks motion of speckle patterns within the myocardial walls to measure changes in length, shape, and rotation of myocardial segments, providing indices of myocardial function that may detect subclinical dysfunction earlier than conventional measures.

While MSI can offer diagnostic or prognostic information—particularly when cardiac MRI is not available—the evidence base is heterogeneous and overall of limited quality. This policy therefore restricts routine coverage to surveillance related to oncology medication exposure that may cause cardiotoxicity and considers other indications experimental or unproven.

Definitions

Myocardial strain imaging (MSI) — definition by speckle-tracking echocardiography

DefinitionMyocardial strain imaging (MSI) by speckle-tracking echocardiography uses image-processing software to track movement of stable speckle patterns (bright and dark acoustic reflections) in myocardial tissue to quantify myocardial deformation and assess severity of myocardial damage and abnormal function.

Imaging principleMSI analyzes reflected ultrasonic waves that create stable speckle patterns which serve as 'fingerprints' to identify and follow specific myocardial wall segments.

MethodSpeckle-tracking software follows the motion of speckles across frames to measure myocardial length, shape, and motion (deformation/strain).

Primary use describedProvides quantitative assessment of myocardial mechanics and can help detect myocardial damage when other modalities are unavailable or infeasible.

Technique characteristicNoninvasive echocardiographic post-processing technique that is applied to standard ultrasound images using specialized software.

OpenPayer

Clinical Review Criteria — Myocardial Strain Imaging (Speckle‑tracking echocardiography)

Coverage Criteria

Coding

Provider Actions / Billing Guidance

Background

Definitions