Appeal type: Imaging
Decision: Partially Favorable

 
We decided that the Plan has to pay for 75726 and 75774 x2. We decided that the Plan does not have to pay for 
75774 x1.  
 
You asked the Plan to pay for angiography services (procedure code 75726, 75774) provided to the enrollee on 
April 20, 2022.. You say that this should be paid for. The Plan says that the records do not support the services 
billed. 
 
We decided that the Plan has to pay for 75726 and 75774 x2.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code.  
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 75726 - angiography, visceral, selective or 
supraselective (with or without flush aortogram), radiological supervision and interpretation, and CPT 75774. 
Our reviewer says that this codes for visceral angiography. This has been satisfactorily documented for the 
Celiac artery. Catheterization and angiographic codes performed prior to vascular embolization are separately 
billable and not included within the embolization code. The catheterization codes have been previously 
approved. 
 
In terms of CPT 75774, there is satisfactory documentation of the interpretation of images resulting from 
catheterization of an abnormal branch off the left hepatic artery and of the right hepatic artery. The first two 
instances of this code are supported by the records. 
 
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 
75726 and 75774 x2.  
 
We also decided that the Plan does not have to pay for 75774 x1. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
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 x1 - angiography, selective, each 
additional vessel studied after basic examination, radiological supervision and interpretation (List separately in 
addition to code for primary procedure). Our reviewer says that this code is an add-on code coding for each 
additional selective angiogram following initial angiography and requires separate positioning of the catheter 
and requires a documented interpretation of the corresponding angiogram.  There is satisfactory documentation 
of the interpretation of images resulting from catheterization of an abnormal branch off the left hepatic artery 
and of the right hepatic artery.  However, there is insufficient description provided in the documentation to 
support coding a third instance of 75774. 
 
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 x1. 
 
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.