CurrentMolina HealthcarePolicy N/A

Diagnostic angiography reimbursement

Defines Molina Healthcare's reimbursement stance and billing guidance for invasive diagnostic angiography (arteriography), the approved places of service, documentation expectations, and state exceptions; affects Molina-contracted providers submitting angiography claims.

Policy Summary

PayerMolina Healthcare

PolicyDiagnostic angiography reimbursement

Policy CodePolicy N/A

Change TypeUpdated State Exceptionstemplate and reference reviews

Effective DateN/A

Next Review DateN/A

Key ActionInclude requisite indicators and documentation with submitted charges per state Medicaid/CMS billing guidelines to avoid denials, audits, or payment disruptions.

SourceLink

POLICY UPDATE CHANGES

Updated State Exceptions.

Updated Template.

Reviewed links.

6document chunks

6places of service listed

2states exempted

3doc history dates

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Coverage criteria for diagnostic angiography

Covered when all of the following place-of-service, clinical, and documentation requirements are met; state-specific exceptions apply.

Coverage and reimbursement governed by place of service, documentation, and state-specific exceptions.

ALL of the following

Place of service: Allowed only in POS 11 (Office), POS 19 (Off‑Campus - Outpatient Hospital), POS 21 (Inpatient Hospital), POS 22 (Outpatient Hospital), POS 23 (Emergency Room - Hospital), or POS 24 (Ambulatory Surgical Center).
Mobile units and all other locations are not covered.

Clinical indication: Invasive diagnostic angiography (arteriography) is reserved for situations where noninvasive imaging (duplex ultrasound, MRA, CTA) yields conflicting results or when angiography is performed in conjunction with a therapeutic procedure.

Billing and documentation: Providers must adhere to state Medicaid and/or CMS billing guidelines and submit the requisite indicators and supporting documentation with charges; failure to do so may result in payment disruptions, denials, or audits.

ALL of the following

State exceptions
- Follow state exception table for state-specific deviations; policy does not apply in TX (Texas).
- Follow state exception table for state-specific deviations; policy does not apply in MI (Michigan).

Coding Guidance

Coding guidancemixed

Coding examples not listed; codes in policy are for reference and not all-inclusive. Providers expected to follow CPT and industry-standard coding practices.

Code validity note — Deleted or inactive codes may not be eligible for reimbursement; listing does not guarantee coverage.

Policy note on deleted/inactive codesDeleted codes and codes not effective at time of service may not be eligible for reimbursement; listing of a code in this policy does not guarantee coverage.

Coding disclaimerCodes listed are for reference only and may not be all-inclusive; providers must follow industry-standard coding practices (CPT®).

Consequences of improper codingMolina may reject/deny claims and recover payments when improper billing and coding practices are identified.

Billing and Place-of-Service Requirements

Documentation Required

Billing and documentation requirements

Adhere to the billing rules of the applicable state Medicaid program and/or CMS; submit all requisite indicators and supporting documentation with charges to avoid claim disruptions, denials, or audits.

Follow billing guidelines prescribed by the applicable state Medicaid program and/or CMS.
Include requisite indicators and documentation with submitted charges to prevent payment disruptions, denials, or audits.

Billing Rule

Place of Service restrictions

Perform and bill invasive diagnostic angiography only in approved Places of Service (POS 11, 19, 21, 22, 23, 24); mobile units and all other locations are not covered.

Allowed POS: POS 11 (Office), POS 19 (Off‑Campus - Outpatient Hospital), POS 21 (Inpatient Hospital), POS 22 (Outpatient Hospital), POS 23 (Emergency Room - Hospital), POS 24 (Ambulatory Surgical Center).
Mobile units and all other locations are explicitly not covered.

Abbreviations and Definitions

CMS — Center for Medicare and Medicaid

Full nameCenter for Medicare and Medicaid (CMS)

Role in policy developmentCMS guidance and manuals were used as source references for this policy.

Reference examplesCMS links cited include MLN6775421 and the Chapter 12 Medicare Claims Processing Manual.

CTA — Computed Tomographic Angiography

TermCTA (Computed Tomographic Angiography)

Definition sourceDefined in policy definitions as Computed Tomographic Angiography.

ContextListed among imaging modalities referenced in the policy background (noninvasive alternative to invasive angiography).