Harvard Pilgrim is updating our Cardiovascular Disease Risk Tests Medical Policy to address additional tests that are considered experimental/investigational or unproven due to inadequate support in the clinical literature, and, therefore, are not covered services.
This policy provides coverage information for diagnostic tests designed to help assess non-traditional risk factors for cardiovascular disease. For dates of service beginning January 1, 2017, Harvard Pilgrim will not cover the following:
- 93050 – Arterial pressure waveform analysis for assessment of central arterial pressures includes waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive
- 93895 – Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral
- 0111T – Long-chain (C20-22) omega-3 fatty acids in red blood cell (RBC) membranes
- 0126T – Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment
- 0337T – Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (e.g., brachial artery ultrasound, peripheral artery tonometry). Unilateral or bilateral
- 0423T – Secretory type II phospholipase A2 (sPLA2-IIA)
For complete information, please refer to the updated Cardiovascular Disease Risk Tests Medical Policy.