Overview
This article provides guidance on when to submit echocardiogram authorizations through the Cohere portal.
Echocardiogram Requests
An echocardiogram, commonly referred to as a cardiac ultrasound, is a useful procedure for many different types of clinical situations, especially when visualizing various structures of the heart and accompanying blood vessels.
Cohere does not decision initial echocardiogram requests; these requests do not require prior authorization through Cohere.
Cohere will manage repeat echocardiogram requests, which we define as having had a non-acute echocardiogram completed within the last 12 months.
To limit delays, ensure you provide proper documentation to demonstrate medical necessity.
Use the following codes for these requests: 93306, 93307, 93308, C8923, C8924, and C8929.
Please refer to the chart below for insight into when a repeat echocardiogram should be requested for various valvular disease diagnoses. Please note that these values may vary depending on the etiology of the valve disease.
Stage/ Diagnosis | Aortic stenosis* | Aortic regurgitation | Mitral stenosis | Mitral regurgitation |
Progress (Stage B) | Mild severity: every 3-5 years | Mild Severity: every 3-5 years | Mitral valve area >1.5 cm^2: Every 3-5 years | Mild severity: every 3-5 years |
Severe asymptomatic (Stage C1) | Every 6 months | Every 6-12 months** | Mitral valve area 1-1.5 cm^2: every 1-2 years Mitral valve area <1 cm^2: every year | Every 6-12 months* |
*Mild severity defined as Vmax 2.0-2.9 m/s, moderate severity defined as 3.0-3.9 m/s and severe asymptomatic as Vmax >4 m/s
**May occur more frequently in the context of a dilating of the left ventricle
Routine repeat assessment of left ventricle function is not indicated for patients with heart failure in the absence of:
Clinical status change
Treatment interventions that might have significant effect on cardiac function
Candidacy for invasive procedures or device therapy.
For more details, please refer to these sources from the ACC/ AHA joint committee on clinical practice guidelines”
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79:e263–e421.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021;77:e25–197