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TRICARE Policy Manual 6010.63-M, April 2021
Medicine
Chapter 7
Section 10.1
Echocardiogram For Dental And Invasive Procedures
Issue Date:  May 24, 1998
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  
1.0  CPT CODE RANGE
93303 - 93350
2.0  DESCRIPTION
An echocardiogram is a non-invasive diagnostic test performed to evaluate the heart’s function. It is able to monitor the performance of the valves. It can help to diagnose structural abnormalities in the heart wall, valves, and blood vessels. It can detect tumors, clots or pericardial effusions (abnormal fluid collection around the heart). It is sometimes used after a heart attack to evaluate the cardiac wall motion and function. The most frequent use of an echocardiogram is for diagnosing or monitoring congenital heart disease, cardiomyopathies or aneurysms.
3.0  POLICY
3.1  An echocardiogram is a covered procedure to evaluate the valves and chambers of the heart, to aid the diagnosis of cardiomyopathies, to detect atrial tumors or pericardial effusions or to evaluate cardiac wall motion and function after a heart attack.
3.2  An echocardiogram is a covered diagnostic procedure for cardiac valvulopathy associated with ingestion of Pondimin and Redux (Phen-Fen):
3.2.1  After a thorough medical history and cardiovascular physical examination reveals a new murmur or symptoms (shortness of breath) of cardiac problems; or
3.2.2  Before dental procedures in patients who have been found to have clinically significant valvular abnormalities. Abnormalities that create the risk for developing endocarditis include, but are not limited to:
3.2.2.1  Implanted heart valves as a replacement for their own heart valve.
3.2.2.2  Abnormal native heart valves (leakage, blockage).
3.2.2.3  Any congenital heart defect (Ventricular Septal Defect (VSD), Atrial Septal Defect (ASD), Patent Ductus Arteriosus (PDA), complex anomaly).
3.2.2.4  Dacron or Teflon vascular grafts or patches over cardiac defects.
3.2.2.5  Mitral valve prolapse - only if there is significant valve leakage.
3.2.2.6  Pacemakers.
- END -

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