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36.4.10.1 Noninvasive Diagnostic Studies
Doppler studies of the extracranial arteries (4/I/T-93875, 4/I/T-93880, and 4/I/T-93882) are limited to the following diagnosis codes:
Doppler studies of the intracranial arteries (4/I/T-93886, 4/I/T-93888, 4/I/T-93890, 4/I/T-93892, and 4/I/T-93893) are limited to the following diagnosis codes:
Doppler studies of the extremity arteries (4/I/T-93922, 4/I/T-93923, 4/I/T-93924, 4/I/T-93925, 4/I/T-93926, 4/I/T-93930, and 4/I/T-93931) are limited to the following diagnosis codes:
Doppler studies of the extremity veins (4/I/T-93965, 4/I/T-93970, and 4/I/T-93971) are limited to the following diagnosis codes:
Procedure code 4/I/T-93325 is payable for the following diagnosis codes:
Procedure codes 4/I/T-93922 and 4/I/T-93923 are limited to diagnosis codes: 44501, 44502, and 78552.
Procedure codes 4/I/T-93924, 4/I/T-93925 and 4/I/T-93926 are limited to diagnosis codes 44502 and 78552.
Procedure codes 4/I/T-93930 and 4/I/T-93931 are limited to the following diagnosis codes: 44501 and 78552.
Multiple Doppler procedures (for example, studies of extra-cranial arteries and intracranial arteries) billed on the same day are reimbursed at full fee for the first, and half for each additional study irrespective of the number of services billed.
Procedure codes described as complete bilateral studies are inclusive codes. Right and left studies submitted with the same date of service will be considered for reimbursement as a quantity of one.
Procedure codes 4/I/T-93882, 4/I/T-93888, 4/I/T-93926, 4/I/T-93931, 4/I/T-93971, 4/I/T-93976, and 4/I/T-93979 are considered unilateral codes. Right and left studies are reimbursed at full and one-half fee.
Procedure codes 4/I/T-93320 and 4/I/T-93321 are reimbursable in addition to procedure codes 4/I/T-93307 and 4/I/T-93308.
Procedure code 4/I/T-93325 may be considered for reimbursement separately from transthoracic and transesophageal echocardiograph procedure codes 4/I/T-93312 and 4/I/T-93350, when billed on the same date of service, by the same provider.
Procedure code 4/I/T-93990 is considered part of the care of the dialysis patient and is not reimbursed separately.
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