P2P Call Guide

How to Win a P2P Call for Cardiac Catheterization Denied by MA Plans

Payer-specific strategy, medical necessity arguments, and the exact phrases to use when Medicare Advantage denies Cardiac Catheterization (CPT 93458, 93459, 93460).

Why MA Plans Denies Cardiac Catheterization

Non-invasive testing not completed first

Stress test results do not meet threshold for catheterization

Stable angina without high-risk features

Know Medicare Advantage's Criteria

Medicare Advantage plans must cover all services covered by Original Medicare (CMS NCDs and LCDs) but may require prior auth. Plans use various criteria including InterQual, MCG, and proprietary guidelines.

Key policies to know:

  • Must cover all services covered by Original Medicare
  • Can require prior authorization not required by Original Medicare
  • CMS NCDs and LCDs serve as coverage floor
  • Organization determinations must be issued within 14 days (72 hours for expedited)

MA Plans's Specific Approach to Cardiac Catheterization

Applicable Policy

No specific CMS NCD for diagnostic cardiac catheterization -- covered under general Medicare benefit

How MA Plans Typically Denies This

MA plans apply their own prior auth criteria, often using InterQual or MCG. Since there's no specific NCD, they have more flexibility. Some MA plans deny catheterization for stable patients meeting only stress test criteria.

Your Strategy for This Payer

Cite ACC/AHA guidelines and Appropriate Use Criteria. Without a specific NCD, the argument is based on standard of care and clinical appropriateness. ACC/AHA guidelines carry significant weight.

Key Phrase to Use on the Call

"Diagnostic catheterization is the standard of care for this clinical presentation per ACC/AHA Guidelines, and this MA plan's prior auth criteria should align with nationally accepted clinical standards."

Building Your Medical Necessity Argument

Reference positive stress test with specific findings

Document unstable symptoms or acute coronary syndrome presentation

Note high-risk features on non-invasive testing

Cite Duke Treadmill Score or imaging results supporting catheterization

P2P Call Tips for MA Plans

Cite the relevant CMS NCD or LCD -- MA plans cannot deny what Medicare covers

If the service has a CMS NCD, that trumps the MA plan's internal criteria

Reference CMS regulations on MA coverage obligations

Request expedited determination if clinical urgency exists

Guidelines to Reference

  • ACC/AHA Guidelines for Coronary Revascularization
  • ACCF Appropriate Use Criteria for Coronary Cath

Relevant CPT Codes

CPT 93458CPT 93459CPT 93460

Specialty: Cardiology

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