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Duplex Scanning

Reimbursement Policy:
Duplex Scanning

Effective Date:
August 16, 2016

Last Revised Date:
September 21, 2016

Purpose:
Provide restrictions on provider types that are eligible to be reimbursed for CPT® code 93880. This policy applies to professional providers.

Scope:
All products are included, except

  • Products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).
  • COB

All Insured and Administrative Services Only (ASO) accounts are included.

Policy:
Horizon BCBSNJ shall consider for reimbursement procedure code 93880 only when performed by a provider who is a board certified specialist in one of the following specialties:

  • Cardiology
  • Cardiovascular disease
  • Cardiothoracic surgery
  • Neurological surgery
  • Neurology
  • Pediatric neurology
  • Radiology
  • Thoracic surgery
  • Vascular surgery

The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.

Procedure:

Deny CPT code 93880 as ineligible when performed by a provider specialty other than Vascular Surgeon, Cardiologist, Neurologist and/or Radiologist.

In denied instances where the provider is participating, there shall be no member liability.

In denied instances where the provider is non-participating, member liability shall be up to the provider’s billed charges.

Limitations and Exclusions:

While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

History:
2/1/2016: Policy Approved
9/21/2016: Additional specialties added: cardiothoracic surgery, cardiovascular disease, neurological surgery, pediatric neurology and thoracic surgery

CPT® is a registered mark of the American Medical Association.

Policy 093_v1.0_09212016