Appeal type: Imaging
Decision: Partially Favorable

 
We decided that the Plan has to pay for 75736. We decided that the Plan does not have to pay for 75774.  
 You asked the Plan to pay for angiography services (procedure codes 75736, 75774) rendered on October 24, 
2022.. You say that this should be paid for. The Plan says that this is part of the primary procedure and not 
eligible for separate payment. 
 
We decided that the Plan has to pay for 75736.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. In this case, the CPT Code Manual definition of 
code 75736 is "Angiography, pelvic, selective or supraselective, radiological supervision and interpretation." 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 75736. Our reviewer says that catheterization 
and initial diagnostic angiography are not components of the embolization code and are separately 
billable. However, angiography performed during the conduct of the embolization including evaluating the 
status of the artery after embolization, is considered a component of the embolization code and is not separately 
billable. In this case, there is satisfactory documentation of selective pelvic angiography after catheterizing 
both internal iliac arteries.  Therefore, coverage of 2 instances of 75736 is appropriate. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
75736.  
 
We also decided that the Plan does not have to pay for 75774. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. In this case, the CPT Code Manual definition of 
code 75774 is "Angiography, selective, each additional vessel studied after basic examination, radiological 
supervision and interpretation (List separately in addition to code for primary procedure)." 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 75774. Our reviewer says that CPT 75774 
codes for the supervision and interpretation of additional angiography; it requires a separate catheterization but 
is primarily an angiography code. In this case the documentation is more supportive that these catheterizations 
were for the performance of the embolization as opposed to providing additional diagnostic angiographic 
details. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 75774 have not been met. Therefore, we decided that the Plan does not have to 
pay for 75774. 
 
If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.