Appeal type: Practitioner Services
Decision: Partially Favorable

 
We decided that the Plan has to pay for procedure code 93306-51. We decided that the Plan does not have to 
pay for procedure code 93880-51.  
 
You asked the Plan to pay for practitioner services provided on July 3, 2022, billed with procedure codes 
93880-51 and 93306-51. You say that the claim is billed correctly and should be paid. The Plan says that 
documentation does not support the billed codes.  
We decided that the Plan has to pay for procedure code 93306-51.  
 
The Plan follows Medicare rules. Medicare rules say that providers/suppliers must report services correctly. 
 
We asked our coding reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request to pay for the practitioner services provided. Our 
reviewer says that documentation supports code 93306 but does not support code 93880. Our physician 
reviewer found that the procedure report does not include sufficient documentation to confirm a complete 
extracranial artery duplex scan (93880). Limited duplex scan, dictation must at least include color and spectral 
doppler, for complete dictation must include arterial inflow and venous outflow and color and spectral 
doppler. Procedure report describes a complete echocardiography, and therefore code 93306 should be covered.  
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the practitioner services provided have been met. Therefore, we decided that the 
Plan has to pay for procedure code 93306-51.  
 
We also decided that the Plan does not have to pay for procedure code 93880-51. 
 
The Plan follows Medicare rules. Medicare rules say that providers/suppliers must report services correctly. 
 
We asked our coding reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request to pay for procedure code 93880-51. Our reviewer says 
that documentation supports code 93306 but does not support code 93880. Our physician reviewer found that 
the procedure report does not include sufficient documentation to confirm a complete extracranial artery duplex 
scan (93880). Limited duplex scan, dictation must at least include color and spectral doppler, for complete 
dictation must include arterial inflow and venous outflow and color and spectral doppler. Procedure report 
describes a complete echocardiography, and therefore code 93306 should be covered.  
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 93880-51 have not been met. Therefore, we decided that the Plan does not have 
to pay for procedure code 93880-51. 
 
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.