by Cheryl Nash


If your practice is performing peripheral arterial studies, the guidelines for doing so are very stringent as compared to venous studies. The list defining medical necessity for arterial scans is lengthy and should be read in its entirety for any physician currently doing or thinking about adding these services to their practice. If you are unsure how to locate your Medicare Administrator’s guidelines for your area do feel free to contact us. In general though:


Medicare states:

Non-invasive peripheral arterial studies performed to establish the level and/or degree of arterial occlusive disease are considered medically necessary if: Signs and/or symptoms of possible limb ischemia are present; and the patient can be medically managed or is a candidate for percutaneous, surgical, diagnostic, or therapeutic procedures.


They then go on to quantify this statement into common indications and limitations.


One limitation I want to highlight is that Medicare does not cover screenings or prophylactic diagnostic studies. Patients who are asymptomatic or only present with a risk factor such as being a smoker do not qualify for these studies and an ABN would need to be signed. Most commercial payers have some similar limitations and do not allow billing a test to a patient unless they knew that it may not be covered beforehand.


As always, read your guidelines prior to implementing any services in your practice to ensure success.  Be sure to review your own internal processes to ensure you are in compliance.


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