For services on or after June 15, 2009, see policy N-25.
Cardiokymography (CKG) is a noninvasive procedure used to detect stress induced abnormalities in the left wall of the heart. This procedure provides an additional means for the diagnosis and assessment of coronary artery disease. Although CKG may be performed as an independent test, the greatest benefit of this test is achieved through its adjunctive use with electrocardiographic (ECG) stress testing.
Indications and Limitations of Coverage
CKG testing is considered a covered service only when used as an adjunct to ECG stress testing if the following conditions are met:
- For male patients, a diagnosis of atypical angina pectoris or nonischemic chest pain (786.5-786.50) must be reported.
- For female patients, a diagnosis of angina (413.9), either typical or atypical must be reported.
Payment for cardiokymography will be denied as not medically necessary when reported with a condition not included on this policy. Effective January 26, 2009, 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.