CardioAccess | ACGHolmes

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ACG

h.o.l.M.E.S.

Automated Clinical Guidelines

Cardiology ACCESS Model

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Cardiac Diagnosis, Medication, & Treatment

BCBSIL
BCBSMT
BCBSNM
BCBSOK
BCBSTX

Ambulatory Cardiac Rhythm Monitoring

Ankle Brachial Index (ABI)

Automated Ambulatory Blood Pressure Monitoring (APBM)

Ambulatory External & Implantable Electrocardio-graphic Monitoring

Cardiac Electrophysiological (EP) Studies

Cardiac Event Detection Monitoring

Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)

Anthem

MA

FloridaBlue

Aetna

Cigna

MA

FloridaBlue

MA

Medicare

Cigna

United

FloridaBlue

Cardiac Telemetry

Cardiology Non-emergent Outpatient Stress Testing

Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, Pacemaker
Monitors

Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress & Stress Echocardiography

Device Physiologic CV Data Element Interrogation

Electrocardiograms

MA

Medicare

Aetna

MA

MA

FEP

Electrophysiology Study with Arrhythmia Induction

Stress Echocardiography

Enhanced External Counterpulsation (EECP)

Holter Monitor

MA

FloridaBlue

Anthem

Aetna

MA

Long-Term Wearable Electrocardiographic Monitoring (WEM)

Microvolt
T-Wave Alternans

Cardiology Non-emergent Outpatient Stress Testing

Noninvasive Tests of Carotid Function

Non-Invasive Programmed Stimulation of AICD

Patient Activated Event Recorder

Perioperative Cardiovascular Evaluation Care Before Noncardiac Surgery

Medicare

MA

MA

MA

Real-Time, Outpatient Cardiac Telemetry

Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs)

Tilt Table Testing

Transtelephonic Monitoring of Cardiac Pacemakers

Aetna

Humana

MA

Interventional Cardiology

Acute Ischemic Stroke Treatments

Alcohol Septal Ablation for Treatment of Hypertrophic Cardiomyopathy

Angioplasty (Extracranial, Intracranial) & Intracranial Aneurysm Repair

Aorta Coronary Bypass Surgery (CABG)

Aortic Valve Replacement

Aorto-Renal Endarterectomy or Bypass Surgery

Aetna

Anthem

Cigna

MA

MA

MA

Arterial Intervention

Ascending Aortic Graft Surgery

Automatic Implantable Cardioverter Defibrillator

Balloon-Expandable Venous Stents

Balloon Valvuloplasty

Biventricular Pacing/Cardiac Resynchronization Therapy

Cardiac Catheter Ablation

Cigna

MA

Aetna

Aetna

Aetna

Aetna

MA

FEP

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Cardiac Catheterization

Cardiac Electrophysiological (EP) Studies

Cardiac PET with CT for Attenuation

Cardiac Resynchronization Therapy (CRT)

Cardiac Resynchronization Therapy & Other Pacing/Defibrillator Treatments for Heart Failure

Carotid, Vertebral & Intracranial Artery Stent Placement with or without Angioplasty

Catheter Based Carotid Artery Digital Angiography

Humana

Anthem

Cigna

MA

Anthem

Cigna

Anthem

MA

Coronary Artery Brachytherapy & Other Adjuncts to Coronary Interventions

Coronary Atherectomy

Coronary Intra Vascular Arterial Ultrasound

Descending Thoracic Aortic Graft Surgery

Diagnostic Coronary Angiography

Dialysis Access Evaluation

Drug-eluting Stents

MA

Aetna

MA

MA

FloridaBlue

Anthem

Anthem

Aetna

Dual Chamber Pacemakers

Elective Percutaneous Coronary Intervention

Embolization Procedures

Endomyocardial Biopsy

Endovascular Femoropopliteal Interventions

Endovascular Procedures for Intracranial Arterial Disease

Endovascular Revascularization (Lower Extremities)

FloridaBlue

Aetna

MA

MA

FEP

Anthem

FloridaBlue

Endovenous Stenting

EPS with AI, Pacing after DI & Atrial or SVT & AP Ablation

Medicare

EPS with Transseptal Left Heart Cath with Arrhythmia Induction & VT Ablation

EPS with AI for AFib AVN & AP Ablation

Cardiac Electrophysiological Studies (EPS) & Catheter Ablation

Extracranial Carotid Angioplasty/ Stenting

Implantable Cardioverter Defibrillators

MA

MA

MA

Anthem

FloridaBlue

Anthem

FEP

FloridaBlue

Implantation of Loop Recorder Systems

Intervention on Adults with Congenital Heart Defects

Intra Cardiac Echocardiography (ICE)

Intracardiac Electrophysiological Studies (EPS) & Catheter Ablation

Intraoperative Ventricular Mapping

Intravascular Coronary & Non-Coronary Brachytherapy

Leadless Cardiac Pacemakers

MA

MA

MA

Humana

BCBSIL
BCBSMT
BCBSNM
BCBSOK
BCBSTX

Anthem

Aetna

Aetna

FEP

Left Atrial Appendage & Cardiac Structural Defect Closure

Lower Extremity Endovascular Procedures

Mitral Valve Surgery

Mechanical Embolectomy for Treatment of Acute Stroke

Non-coronary Vascular Stents: Brachiocephalic Arteries

Non-coronary Vascular Stents: Lower Extremity Arteries

Non-coronary Vascular Stents: Pulmonary Artery

United

MA

Anthem

United

Medicare

Medicare

Medicare

Non-coronary Vascular Stents: Renal Artery

Non-coronary Vascular Stents: Venous Stents

Non-coronary Vascular Stents: Mesenteric Vessels

Nonpharmacological Treatment for Atrial Fibrillation

Pacemakers

Catheter Based Closure of Patent Foramen Ovale

Percutaneous Closure of Patent Foramen Ovale (PFO)

Medicare

Medicare

Anthem

Medicare

Cigna

Cigna

Anthem

MA

MA

Percutaneous Coronary Intervention

Percutaneous Iliocaval Interventions

Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)

Pericardial Disease Interventions

Peripheral Atherectomy & Thrombectomy Devices

Peripheral Vascular Stents

FloridaBlue

Anthem

MA

FloridaBlue

Humana

Aetna

MA

Aetna

MA

Medicare

Phrenic Nerve Stimulator
(NCD 160.19)

Renal Angiography

MA

Thrombectomy Systems

Aetna

Transcatheter Edge to Edge Repair (TEER) of Mitral Valve

MA

Transcatheter Valve Procedures

Humana

Vascular Stenting of Lower Extremity Arteries

Renal Artery Intervention

MA

Transcatheter Ablation for Management of Atrial Fibrillation

Anthem

Transcatheter Heart Valve Procedures

Anthem

Cigna

United

Transcoronary Ablation of Septal Hypertrophy (TASH)

Vena Cava Filters

MA

Single Chamber Pacemaker

Transcatheter Ablation for the Treatment of Supraventricular & Ventricular Arrhythmias

Anthem

Cigna

Transcatheter Intravascular Stents

Humana

Treatment for Varicose Veins & Venous Insufficiency

FloridaBlue

UHC

Venous Angioplasty with or without Stent Placement or Venous Stenting Alone

Cigna

Stenting for Iliac Vein Compression for May-Thurner Syndrome

MA

Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins

Anthem

Transcatheter Mitral Valve Repair

FEP

Humana

Medicare

Treatment for Varicose Veins & Venous Insufficiency

Cigna

Medicare

Ventricular Assist Device (VAD), Percutaneous & Permanent

MA

Subcutaneous ICD Device Implantation & Removal

MA

Aetna

Transcatheter Aortic Valve Implantation - Replacement

FloridaBlue

Humana

Transcatheter Placement of Intracranial Stent

Tricuspid Valve Surgery

MA

Ventricular Assist Devices (VADs), Percutaneous Cardiac Support Systems & Total Artificial Heart

Cigna

FEP

Synchronized Electrical Cardioversion

MA

Transcatheter Closure of Cardiovascular Defects

Cigna

Transcatheter Procedures for Heart Valve Conditions

UHC

T-Wave Alternans

Aetna

Wearable & Non-Wearable Cardioverter Defibrillators (WCD) for the Prevention of Sudden Cardiac Death

Anthem

Cigna

FloridaBlue

Temporal Artery Biopsy

MA

Transcatheter Closure of Septal Defects

Transcatheter Pulmonary Valve Implantation

FloridaBlue

Humana

Vascular Embolization & Occlusion

Anthem

Wireless Pulmonary Artery Pressure Device Placement & Monitoring

MA

Abdominal Aortic Aneurysm Screening

Aetna

Cardiac Magnetic Resonance Imaging

Cigna

FloridaBlue

MA

Computed Tomographic Angiography (CTA) Heart

FEP

FloridaBlue

Duplex Scanning of Aorta, Inferior Vena Cava, Iliac Vasculature, or Bypass Grafts

MUGA Scan

FloridaBlue

Transthoracic Echocardiography (TTE)

Cigna

MA

Absolute Quantitation of Myocardial Blood Flow Measurement

Indicates Non-covered Service

Anthem

Aortography & Peripheral Angiography Thoracic & Carotid Aortography

Cardiac PET

FloridaBlue

Coronary Artery Calcium Scoring and Coronary Computed Tomography Angiography

Humana

Echocardio-graphy

FloridaBlue

Myocardial Perfusion Imaging

FloridaBlue

Ultrasound-Guided Vascular Access

MA

Intracardiac Ischemia Monitoring

Anthem

Imaging

Arterial Duplex

MA

Cardiac Single-Photon Emission Computed Tomography (SPECT)

Humana

Coronary & Cardiac Computed Tomographic Angiography

MA

Echocardiography done with Ultrasound Enhancing Agent (UEA)

Pharmacological Nuclear Stress Test/Myocardial Perfusion Imaging (MPI)

MA

Venous Duplex

MA

Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure

Arterial PVR & Stress Arterial PVR

MA

Cardiovascular Nuclear Medicine - Cardiac Blood Pool Studies

Cardiac Computed Tomography (CCT) & Coronary Computed Tomography Angiography (CCTA)

Fractional Flow Reserve CT

FEP

MA

Radionuclide Angiography (MUGA SCAN)

MA

Vessel Mapping for Hemodialysis Access or CABG PAD Surgery

MA

Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management

Anthem

Cardiac Catheterization

Humana

Cardiovascular Nuclear Medicine - Infarct Avidity Studies

Coronary Artery Calcium Scoring by Electron-Beam Tomography or Non-Contrast Coronary CT

MA

Intracoronary Doppler Ultrasound

Stress Echocardio-graphy

Signal Averaged Electrocar-diography (SAECG)

FloridaBlue

Cardiac Imaging

Aetna

Anthem

Cigna

United

Cardiovascular Nuclear Medicine - Perfusion with or without Functional Studies

CT Heart

FloridaBlue

Magnetic resonance imaging (MRI) of the cardiovascular system

Aetna

Transesophageal Echocardiography (TEE)

Ultrafiltration in Decompensated Heart Failure

Anthem

Cardiac Imaging

BCBSMI

BCBSNC

BCBSNJ

BCBSTX

FloridaBlue

MassBlue

Color-Flow Doppler Echocardiography in Adults

Duplex Scan of Hemodialysis Access

MA

MRI of the Heart

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