The advent of multi-slice imaging and enhanced imaging techniques has allowed for the generation of three-dimensional images. Applications of this technology include visualization of central nervous system vasculature, coronary artery imaging, enhanced imaging of the thorax to include embolic disease, inflammatory and neoplastic lesions, and multiple others. The advent of multi-slice imaging and enhanced imaging techniques has allowed for the generation of three-dimensional images. Applications of this technology include visualization of central nervous system vasculature, coronary artery imaging, enhanced imaging of the thorax to include embolic disease, inflammatory and neoplastic lesions, and multiple others.

No more than 20 percent of the total Computerized Tomography (CT) and Magnetic Resonance (MR) imaging of any practice is expected to be submitted with 3-D rendering or interpretation, with or without image post-processing. For non-hospital based outpatient services, it is expected that the referring physician will generate a written request indicating the clinical need for the additional 3-D imaging, a copy of that request will be maintained by the interpreting physician, and the interpreting physician’s report will address those specific clinical issues. In the event that a 3-D interpretation is deemed urgently needed by the radiologist and the referring physician is not immediately available, the radiologist must document the time of the study, the specific need for the study, and a summary of the findings that were urgently transmitted to the practitioner named as the referring physician on the radiology report. Ordering physician requirements for services to hospital inpatients are found at 42 CFR 482.26(b)(4). Ordering physician requirements for services to hospital outpatients are found at 42 CFR 410.32(a), 42 CFR 410.32(d)(2) through (4), and 42 CFR 410.32(e).

Reasons for Noncoverage

CPT codes 76376 and 76377 may be considered medically unnecessary and denied if equivalent information to that obtained from the test has already been provided by another procedure (magnetic resonance imaging, ultrasound, angiography, etc.) or could be provided by a standard CT scan (two-dimensional) without reconstruction. A provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement, in the form of a Pre-Service Denial Notice, should be maintained in the provider's records.

Documentations Requirements

Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record and made available upon request.

Use of one of the secondary diagnosis codes in this LCD implies medical necessity for 3-D rendering and interpretation. Documentation supporting medical necessity must be maintained in the medical record along with the written request for the study from the referring physician.

Documentation of the time of the study, the specific need for the study, and the summary of the findings that were urgently transmitted to the practitioner named as the referring physician must be maintained by the radiologist and made available upon request.

Provider News

04/2012, Medicare Advantage: 3D interpretation and reporting of imaging studies may not be covered.

*Effective 10/01/2011

Note: 793.1 was deleted 10/01/2011