Appeal type: Imaging
Decision: Partially Favorable

 
We decided that the Plan has to pay for 77001, 75726, and 75774. We decided that the Plan does not have to 
pay for 75887.  
 
You asked the Plan to pay for procedure codes 75726, 75774, 75887, and 77001 rendered on November 7, 
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 CPT 77001, CPT 75726, and CPT 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 the overturned codes is: 
 
CPT 75726: 
 
Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision 
and interpretation 
 
CPT 75774: 
 
Angiography, selective, each additional vessel studied after basic examination, radiological supervision and 
interpretation (List separately in addition to code for primary procedure) 
 
CPT 77001: 
 
Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or 
removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast 
injections through access site or catheter with related venography radiologic supervision and interpretation, and 
radiographic documentation of final catheter position) (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 these codes. Our reviewer says that in terms of CPT 
77001, the enrollee underwent placement of a central venous catheter, and this was covered and coded with 
CPT 36561. The use of fluoroscopic guidance for this procedure is separately billable and not bundled into 
CPT 36561.  The code for fluoroscopic guidance is CPT  77001 and there is satisfactory documentation that 
this was utilized during the procedure.  
 
In terms of CPT 75726 and CPT 75774, these codes for visceral angiography and additional angiography via a 
separate vessel cannulation respectively and there is satisfactory documentation that this work has been 
rendered and the findings appropriately documented. 
 
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 
77001, 75726, and 75774.  
 
We also decided that the Plan does not have to pay for CPT 75887. 
 
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 CPT 75887 is "Percutaneous transhepatic portography without 
hemodynamic evaluation, 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 75887. Our reviewer says that there is no 
documentation that a percutaneous transhepatic access was performed and therefore billing for CPT 75887 
does not appear to be justified. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 75887 have not been met. Therefore, we decided that the Plan does not have to 
pay for 75887. 
 
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.