Medical Policy An independent licensee of the Blue Cross Blue Shield Association

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1 Cardiovascular Magnetic Resonance (CMR) Page 1 of 16 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Cardiovascular Magnetic Resonance (CMR) Professional Institutional Original Effective Date: August 4, 2005 Original Effective Date: July 1, 2006 Revision Date(s): February 27, 2006, Revision Date(s):May 2, 2007; May 2, 2007; November 1, 2007; November 1, 2007; January 1, 2010; January 1, 2010; February 15, 2013; February 15, 2013; December 11, 2013; December 11, 2013; April 15, 2014 April 15, 2014; July 15, 2014; July 15, 2014; June 10, 2015; June 10, 2015; June 8, 2016; June 8, 2016; October 1, 2016; October 1, 2016; May 10, 2017 May 10, 2017 Current Effective Date: July 15, 2014 Current Effective Date: July 15, 2014 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. If your patient is covered under a different Blue Cross and Blue Shield plan, please refer to the Medical Policies of that plan. DESCRIPTION Cardiovascular magnetic resonance (CMR) is established in clinical practice for the diagnosis and management of disorders of the cardiovascular system. CMR has several advantages over other imaging modalities: Non-invasive No ionizing radiation No known clinical side effects

2 Cardiovascular Magnetic Resonance (CMR) Page 2 of 16 Soft tissue imaging is superior No imaging artifact from bone Equal clarity in any view: axial, sagittal, coronal, or oblique Ability to acquire two, three, and four-dimensional data Disadvantages of CMR include: Requires more patient cooperation Longer imaging times Incompatibility with various medical and life support devices Attraction of ferromagnetic objects Cost (When applied appropriately with state of the art MRI technology and expertise, initial test cost may be offset by a reduction in downstream utilization of other redundant imaging tests. CMR has the potential to provide a comprehensive examination in one setting at considerably less risk and cost to the patient.)

3 Cardiovascular Magnetic Resonance (CMR) Page 3 of 16 POLICY A. Medically necessary indications for CMR include: 1. Congenital heart disease a. Assessment of shunt size b. Situs anomalies with complex congenital heart disease c. Anomalous pulmonary venous return, especially in complex anomalies and cor triatriatum d. Anomalous systemic venous return e. Systemic or pulmonary venous obstruction f. Ventricular Septal Defect (VSD) associated with complex anomalies g. Supracristal VSD h. Evaluation of right and left ventricular volumes, mass and function i. Pulmonary regurgitation j. Supravalvular aortic stenosis k. Post-operative follow-up of shunts l. Aortic (sinus Valsalva) aneurysm m. Aortic coarctation n. Vascular rings o. Aortopulmonary window p. Anomalous origin of coronary arteries q. Pulmonary atresia r. Central pulmonary stenosis s. Systemic to pulmonary collaterals 2. Acquired diseases of the vessels a. Diagnosis and follow-up of thoracic and abdominal aortic aneurysm including Marfan disease b. Diagnosis and follow-up of chronic aortic dissection c. Diagnosis of aortic intramural hemorrhage d. Diagnosis of penetrating ulcers of the aorta e. Pulmonary artery anatomy and flow f. Assessment of thoracic, abdominal and pelvic veins g. Assessment of renal arteries h. Assessment of iliac, femoral and lower leg arteries i. Assessment of thoracic great vessel origins j. Assessment of cervical carotid arteries k. Assessment of pulmonary veins including one in association with an electrophysiology ablation for atrial fibrillation 3. Coronary artery disease a. Assessment of global ventricular (left and right) function and mass b. Coronary anomalies c. Acute and chronic myocardial infarction - detection and assessment; myocardial viability

4 Cardiovascular Magnetic Resonance (CMR) Page 4 of Pericardial disease, cardiac tumors, cardiomyopathies and cardiac transplants a. Detection and characterization of cardiac and pericardiac tumors b. Hypertrophic cardiomyopathy c. Dilated cardiomyopathy - differentiation from dysfunction related to coronary artery disease d. Arrhythmogenic right ventricular cardiomyopathy (dysplasia) e. Siderotic cardiomyopathy (in particular thalassemia) f. Restrictive cardiomyopathy 5. Valvular heart disease a. Cardiac chamber anatomy and function b. Quantification of regurgitation or stenosis B. Experimental / investigational indications: 1. CMR as a screening test 2. Coronary MRA for screening of coronary artery disease C. Subject to review for medical necessity: 1. CMR for indications that are not listed above 2. Duplication of services such as CT scan, radionuclide studies, ultrasound, and MRI CODING The following codes for treatment and procedures applicable to this policy are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement. Please refer to the member's contract benefits in effect at the time of service to determine coverage or noncoverage of these services as it applies to an individual member. CPT/HCPCS Cardiac magnetic resonance imaging for morphology and function without contrast material; Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure)

5 Cardiovascular Magnetic Resonance (CMR) Page 5 of 16 ICD-9 Diagnoses Diagnoses are otherwise subject to medical policy as stated above Cardiovascular syphilis; Aneurysm of aorta, specified as syphilitic Cardiovascular syphilis; Syphilitic aortitis Syphilitic endocarditis; valve, unspecified Syphilitic endocarditis; mitral valve Syphilitic endocarditis; aortic valve Syphilitic endocarditis; tricuspid valve Syphilitic endocarditis; pulmonary valve Other specified cardiovascular syphilis; syphilitic pericarditis Other specified cardiovascular syphilis; syphilitic myocarditis Other specified cardiovascular syphilis; other Cardiovascular syphilis, unspecified Malignant neoplasm of trachea, bronchus, and lung; main bronchus Malignant neoplasm of trachea, bronchus, and lung; upper lob, bronchus or lung Malignant neoplasm of trachea, bronchus, and lung; middle lobe, bronchus or lung Malignant neoplasm of trachea, bronchus, and lung; lower lobe, bronchus or lung Malignant neoplasm of trachea, bronchus, and lung; other parts of bronchus or lung Malignant neoplasm of trachea, bronchus, and lung; bronchus and lung, unspecified Malignant neoplasm of pleura; parietal pleura Malignant neoplasm of pleura; visceral pleura Malignant neoplasm of pleura; other specified sites of pleura Malignant neoplasm of pleura; pleura, unspecified Malignant neoplasm of bronchus, lung, pleura, thymus, heart, and mediastinum; heart Malignant neoplasm of bronchus, lung, pleura, thymus, heart, and mediastinum; anterior mediastinum Malignant neoplasm of bronchus, lung, pleura, thymus, heart, and mediastinum; posterior mediastinum Malignant neoplasm of bronchus, lung, pleura, thymus, heart, and mediastinum; other Malignant neoplasm of bronchus, lung, pleura, thymus, heart, and mediastinum; mediastinum, part unspecified Malignant neoplasm of connective and other soft tissue; thorax Secondary malignant neoplasm of respiratory and digestive systems; lung Secondary malignant neoplasm of respiratory and digestive systems; mediastinum Secondary malignant neoplasm of respiratory and digestive systems; pleura Benign neoplasm of respiratory and intrathoracic organs; bronchus and lung Benign neoplasm of respiratory and intrathoracic organs; pleura Benign neoplasm of respiratory and intrathoracic organs; mediastinum Benign neoplasm of respiratory and intrathoracic organs; thymus Benign neoplasm of respiratory and intrathoracic organs; heart Lipoma; intrathoracic organs Other benign neoplasm of connective and other soft tissue; thorax Neoplasm of uncertain behavior of digestive and respiratory systems; trachea, bronchus, and lung Neoplasm of uncertain behavior of digestive and respiratory systems; pleura, thymus, and mediastinum

6 Cardiovascular Magnetic Resonance (CMR) Page 6 of Rheumatic fever without mention of heart involvement Rheumatic fever with heart involvement; acute rheumatic pericarditis Rheumatic fever with heart involvement; acute rheumatic endocarditis Rheumatic fever with heart involvement; acute rheumatic myocarditis Rheumatic fever with heart involvement; other acute rheumatic heart disease Rheumatic fever with heart involvement; acute rheumatic heart disease, unspecified Rheumatic chorea; with heart involvement Rheumatic chorea; without mention of heart involvement 393 Chronic rheumatic pericarditis Diseases of mitral valve; mitral stenosis Diseases of mitral valve; rheumatic mitral insufficiency Diseases of mitral valve; mitral stenosis with insufficiency Diseases of mitral valve; other and unspecified mitral valve diseases Diseases of aortic valve; rheumatic aortic stenosis Diseases of aortic valve; rheumatic aortic insufficiency Diseases of aortic valve; rheumatic aortic stenosis with insufficiency Diseases of aortic valve; other and unspecified rheumatic aortic diseases Diseases of mitral and aortic valves; mitral valve stenosis and aortic valve stenosis Diseases of mitral and aortic valves; mitral valve stenosis and aortic valve Diseases of mitral and aortic valves; mitral valve insufficiency and aortic valve Diseases of mitral and aortic valves; mitral valve insufficiency and aortic valve insufficiency Diseases of mitral and aortic valves; multiple involvement of mitral and aortic valves Diseases of mitral and aortic valves; mitral and aortic valve diseases, unspecified Diseases of other and endocardial structures; diseases of tricuspid valve Diseases of other and endocardial structures; rheumatic diseases of pulmonary valve Diseases of other and endocardial structures; rheumatic diseases of endocardium, valve unspecified Other rheumatic heart disease; rheumatic myocarditis Other and unspecified rheumatic heart diseases; rheumatic heart disease, unspecified Other and unspecified rheumatic heart diseases; rheumatic heart failure (congestive) Other and unspecified rheumatic heart diseases; other Acute myocardial infarction of anterolateral wall, episode of care unspecified Acute myocardial infarction of anterolateral wall, initial episode of care Acute myocardial infarction of anterolateral wall, subsequent episode of care Acute myocardial infarction of other anterior wall, episode of care unspecified Acute myocardial infarction; of other anterior wall, initial episode of care Acute myocardial infarction of other anterior wall, subsequent episode of care Acute myocardial infarction of inferolateral wall, episode of care unspecified Acute myocardial infarction of inferolateral wall, initial episode of care Acute myocardial infarction of inferolateral wall, subsequent episode of care Acute myocardial infarction of inferoposterior wall, episode of care unspecified Acute myocardial infarction of inferoposterior wall, initial episode Acute myocardial infarction of inferoposterior wall, subsequent episode of care Acute myocardial infarction of other inferior wall, episode of care unspecified

7 Cardiovascular Magnetic Resonance (CMR) Page 7 of Acute myocardial infarction of other inferior wall, initial episode of care Acute myocardial infarction of other inferior wall, subsequent episode of care Acute myocardial infarction of other lateral wall, episode of care unspecified Acute myocardial infarction of other lateral wall, initial episode of care Acute myocardial infarction of other lateral wall, subsequent episode of care Acute myocardial infarction, true posterior wall infarction, episode of care unspecified Acute myocardial infarction, true posterior wall infarction, initial episode of care Acute myocardial infarction, true posterior wall infarction, subsequent episode of care Acute myocardial infarction, subendocardial infarction, episode of care unspecified Acute myocardial infarction, subendocardial infarction, initial episode of care Acute myocardial infarction, subendocardial infarction, subsequent episode of care Acute myocardial infarction of other specified sites, episode of care unspecified Acute myocardial infarction of other specified sites, initial episode of care Acute myocardial infarction of other specified sites, subsequent episode of care Acute myocardial infarction, unspecified, episode of care unspecified Acute myocardial infarction, initial episode of care Acute myocardial infarction of other specified sites, subsequent episode of care Other acute and subacute forms of ischemic heart disease; postmyocardial infarction syndrome Other acute and subacute forms of ischemic heart disease; intermediate coronary syndrome Other acute and subacute forms of ischemic heart disease; acute coronary occlusion without myocardial infarction Other acute and subacute forms of ischemic heart disease; other Pulmonary embolism and infarction; iatrogenic pulmonary embolism and infarction Pulmonary embolism and infarction; septic pulmonary embolism Pulmonary embolism and infarction; other Other diseases of pulmonary circulation; arteriovenous fistula of pulmonary vessels Other diseases of pulmonary circulation; aneurysm of pulmonary artery Other diseases of pulmonary circulation; other specified diseases of pulmonary circulation Acute pericarditis; in diseases classified elsewhere Other and unspecified acute pericarditis; acute pericarditis, unspecified` Other and unspecified acute pericarditis; acute idiopathic pericarditis Other and unspecified acute pericarditis; other Acute and subacute endocarditis; acute and subacute bacterial endocarditis Acute and subacute endocarditis; acute and subacute infective endocarditis in diseases classified elsewhere Acute and subacute endocarditis; acute endocarditis, unspecified Acute myocarditis; acute myocarditis in diseases classified elsewhere Acute myocarditis; acute myocarditis, unspecified Acute myocarditis; idiopathic myocarditis Acute myocarditis; septic myocarditis Acute myocarditis; toxic myocarditis Acute myocarditis; toxic myocarditis Other diseases of pericardium; hemopericardium

8 Cardiovascular Magnetic Resonance (CMR) Page 8 of Other diseases of pericardium; adhesive pericarditis Other diseases of pericardium; constrictive pericarditis Other diseases of pericardium; cardiac tamponade Other diseases of pericardium; other specified diseases of pericardium Other diseases of pericardium; unspecified disease of pericardium Other diseases of endocardium; mitral valve disorders Other diseases of endocardium; aortic valve disorders Other diseases of endocardium; tricuspid valve disorders, specified as non-rheumatic Other diseases of endocardium; pulmonary valve disorders Other diseases of endocardium; endocarditis, valve unspecified, unspecified cause Other diseases of endocardium; endocarditis in diseases classified elsewhere Other diseases of endocardium; other Aortic aneurysm and dissection; Dissection of aorta; unspecified site Aortic aneurysm and dissection; Dissection of aorta; thoracic Aortic aneurysm and dissection; Dissection of aorta; abdominal Aortic aneurysm and dissection; Dissection of aorta; thoracoabdominal Aortic aneurysm and dissection; Thoracic aneurysm, ruptured Aortic aneurysm and dissection; Thoracic aneurysm without mention of rupture Aortic aneurysm and dissection; Abdominal aneurysm, ruptured Aortic aneurysm and dissection; Abdominal aneurysm without mention of rupture Aortic aneurysm and dissection; Aortic aneurysm of unspecified site, ruptured Aortic aneurysm and dissection; Thoracoabdominal aneurysm, ruptured Aortic aneurysm and dissection; Thoracoabdominal aneurysm, without mention of rupture Aortic aneurysm and dissection; Aortic aneurysm of unspecified site without mention of rupture Arterial embolism and thrombosis; of the abdominal aorta; saddle embolus of abdominal aorta Arterial embolism and thrombosis; of the abdominal aorta; other arterial embolism and thrombosis of abdominal aorta Arterial embolism and thrombosis; of thoracic aorta 452 Portal vein thrombosis Other venous embolism and thrombosis; Budd-Chiari syndrome Other venous embolism and thrombosis; of vena cava Pleurisy; without mention of effusion or current tuberculosis Pleurisy; with effusion, with mention of a bacterial cause other than tuberculosis Pleurisy; other specified forms of effusion, except tuberculous Liver abscess and sequelae of chronic liver disease; portal pyemia Bulbus cordis anomalies and anomalies of cardiac septal closure; common truncus Transposition of great vessels; complete transposition of great vessels Transposition of great vessels; double outlet right ventricle Transposition of great vessels; corrected transposition of great vessels Transposition of great vessels; other Bulbus cordis anomalies and anomalies of cardiac septal closure; Tetralogy of Fallot Bulbus cordis anomalies and anomalies of cardiac septal closure; common ventricle Bulbus cordis anomalies and anomalies of cardiac septal closure; ventricular septal defect

9 Cardiovascular Magnetic Resonance (CMR) Page 9 of Bulbus cordis anomalies and anomalies of cardiac septal closure; ostium secundum type atrial septal defect Endocardial cushion defects; unspecified type Endocardial cushion defects; ostium primum defect Endocardial cushion defects; other Bulbus cordis anomalies and anomalies of cardiac septal closure; cor biloculare Bulbus cordis anomalies and anomalies of cardiac septal closure; other Bulbus cordis anomalies and anomalies of cardiac septal closure; unspecified defect of septal closure Anomalies of pulmonary valve; pulmonary valve anomaly, unspecified Anomalies of pulmonary valve; atresia, congenital Anomalies of pulmonary valve; stenosis, congenital Anomalies of pulmonary valve; other Other congenital anomalies of heart; tricuspid atresia and stenosis, congenital Other congenital anomalies of heart; Ebstein's anomaly Other congenital anomalies of heart; congenital stenosis of aortic valve Other congenital anomalies of heart; congenital insufficiency of aortic valve Other congenital anomalies of heart; congenital mitral stenosis Other congenital anomalies of heart; congenital mitral insufficiency Other congenital anomalies of heart; hypoplastic left heart syndrome Other specified anomalies of heart; subaortic stenosis Other specified anomalies of heart; cor triatriatum Other specified anomalies of heart; infundibular pulmonic stenosis Other specified anomalies of heart; obstructive anomalies of heart, not elsewhere classified Other specified anomalies of heart; coronary artery anomaly Other specified anomalies of heart; congenital heart block Other specified anomalies of heart; malposition of heart and cardiac apex Other specified anomalies of heart; other Unspecified anomaly of heart Other congenital anomalies of circulatory system; patent ductus arteriosus Coarctation of aorta; (preductal) (postductal) Coarctation of aorta; interruption of aortic arch Other anomalies of aorta; unspecified Other anomalies of aorta; anomalies of aortic arch Other anomalies of aorta; atresia and stenosis or aorta Other anomalies of aorta; other Anomalies of pulmonary artery; pulmonary artery coarctation and atresia Anomalies of pulmonary artery; pulmonary arteriovenous malformation Anomalies of pulmonary artery; other anomalies of pulmonary artery and pulmonary circulation Anomalies of great veins; unspecified Anomalies of great veins; total anomalous pulmonary venous connection Anomalies of great veins; partial anomalous pulmonary venous connection Anomalies of great veins; other anomalies of great veins Other specified anomalies; Marfan syndrome Chest pain; swelling, mass, or lump in chest

10 Cardiovascular Magnetic Resonance (CMR) Page 10 of Nonspecific abnormal findings on radiological and other examination of body structure; other intrathoracic organs Cardiovascular; abnormal function study, unspecified Cardiovascular; abnormal electrocardiogram [ECG] [EKG] V45.82 Other postprocedural status; percutaneous transluminal coronary angioplasty status ICD-10 Diagnoses A18.84 Tuberculosis of heart A52.00 Cardiovascular syphilis, unspecified A52.01 Syphilitic aneurysm of aorta A52.02 Syphilitic aortitis A52.03 Syphilitic endocarditis A52.04 Syphilitic cerebral arteritis A52.06 Other syphilitic heart involvement A52.09 Other cardiovascular syphilis C34.01 Malignant neoplasm of right main bronchus C34.02 Malignant neoplasm of left main bronchus C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.12 Malignant neoplasm of upper lobe, left bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung C34.32 Malignant neoplasm of lower lobe, left bronchus or lung C34.80 Malignant neoplasm of overlapping sites of unspecified bronchus and lung C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung C38.0 Malignant neoplasm of heart C38.1 Malignant neoplasm of anterior mediastinum C38.2 Malignant neoplasm of posterior mediastinum C38.3 Malignant neoplasm of mediastinum, part unspecified C38.4 Malignant neoplasm of pleura C38.8 Malignant neoplasm of overlapping sites of heart, mediastinum and pleura C45.0 Mesothelioma of pleura C45.2 Mesothelioma of pericardium C47.3 Malignant neoplasm of peripheral nerves of thorax C49.3 Malignant neoplasm of connective and soft tissue of thorax C78.01 Secondary malignant neoplasm of right lung C78.02 Secondary malignant neoplasm of left lung C78.1 Secondary malignant neoplasm of mediastinum C78.2 Secondary malignant neoplasm of pleura D14.31 Benign neoplasm of right bronchus and lung D14.32 Benign neoplasm of left bronchus and lung D15.0 Benign neoplasm of thymus D15.1 Benign neoplasm of heart D15.2 Benign neoplasm of mediastinum D17.4 Benign lipomatous neoplasm of intrathoracic organs D19.0 Benign neoplasm of mesothelial tissue of pleura D21.3 Benign neoplasm of connective and other soft tissue of thorax D38.1 Neoplasm of uncertain behavior of trachea, bronchus and lung

11 Cardiovascular Magnetic Resonance (CMR) Page 11 of 16 D38.2 Neoplasm of uncertain behavior of pleura D38.3 Neoplasm of uncertain behavior of mediastinum D38.4 Neoplasm of uncertain behavior of thymus I00 Rheumatic fever without heart involvement I01.0 Acute rheumatic pericarditis I01.1 Acute rheumatic endocarditis I01.2 Acute rheumatic myocarditis I01.8 Other acute rheumatic heart disease I02.0 Rheumatic chorea with heart involvement I02.9 Rheumatic chorea without heart involvement I05.0 Rheumatic mitral stenosis I05.1 Rheumatic mitral insufficiency I05.2 Rheumatic mitral stenosis with insufficiency I05.8 Other rheumatic mitral valve diseases I06.0 Rheumatic aortic stenosis I06.1 Rheumatic aortic insufficiency I06.2 Rheumatic aortic stenosis with insufficiency I06.8 Other rheumatic aortic valve diseases I07.0 Rheumatic tricuspid stenosis I07.1 Rheumatic tricuspid insufficiency I07.2 Rheumatic tricuspid stenosis and insufficiency I07.8 Other rheumatic tricuspid valve diseases I08.0 Rheumatic disorders of both mitral and aortic valves I08.1 Rheumatic disorders of both mitral and tricuspid valves I08.2 Rheumatic disorders of both aortic and tricuspid valves I08.3 Combined rheumatic disorders of mitral, aortic and tricuspid valves I08.8 Other rheumatic multiple valve diseases I09.0 Rheumatic myocarditis I09.1 Rheumatic diseases of endocardium, valve unspecified I09.2 Chronic rheumatic pericarditis I09.81 Rheumatic heart failure I09.89 Other specified rheumatic heart diseases I20.0 Unstable angina I24.0 Acute coronary thrombosis not resulting in myocardial infarction I24.1 Dressler's syndrome I24.8 Other forms of acute ischemic heart disease I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris I Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris I Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris I Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris I Atherosclerosis of native coronary artery of transplanted heart with unstable angina I Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina I Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris

12 Cardiovascular Magnetic Resonance (CMR) Page 12 of 16 I26.01 Septic pulmonary embolism with acute cor pulmonale I26.09 Other pulmonary embolism with acute cor pulmonale I26.90 Septic pulmonary embolism without acute cor pulmonale I26.99 Other pulmonary embolism without acute cor pulmonale I28.0 Arteriovenous fistula of pulmonary vessels I28.1 Aneurysm of pulmonary artery I28.8 Other diseases of pulmonary vessels I30.0 Acute nonspecific idiopathic pericarditis I30.1 Infective pericarditis I30.8 Other forms of acute pericarditis I31.0 Chronic adhesive pericarditis I31.1 Chronic constrictive pericarditis I31.2 Hemopericardium, not elsewhere classified I31.3 Pericardial effusion (noninflammatory) I31.4 Cardiac tamponade I31.8 Other specified diseases of pericardium I32 Pericarditis in diseases classified elsewhere I33.0 Acute and subacute infective endocarditis I33.9 Acute and subacute endocarditis, unspecified I34.0 Nonrheumatic mitral (valve) insufficiency I34.1 Nonrheumatic mitral (valve) prolapse I34.2 Nonrheumatic mitral (valve) stenosis I34.8 Other nonrheumatic mitral valve disorders I35.0 Nonrheumatic aortic (valve) stenosis I35.1 Nonrheumatic aortic (valve) insufficiency I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency I35.8 Other nonrheumatic aortic valve disorders I36.0 Nonrheumatic tricuspid (valve) stenosis I36.1 Nonrheumatic tricuspid (valve) insufficiency I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency I36.8 Other nonrheumatic tricuspid valve disorders I37.0 Nonrheumatic pulmonary valve stenosis I37.1 Nonrheumatic pulmonary valve insufficiency I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency I37.8 Other nonrheumatic pulmonary valve disorders I38 Endocarditis, valve unspecified I39 Endocarditis and heart valve disorders in diseases classified elsewhere I40.0 Infective myocarditis I40.1 Isolated myocarditis I40.8 Other acute myocarditis I41 Myocarditis in diseases classified elsewhere I71.01 Dissection of thoracic aorta I71.02 Dissection of abdominal aorta I71.03 Dissection of thoracoabdominal aorta I71.1 Thoracic aortic aneurysm, ruptured I71.2 Thoracic aortic aneurysm, without rupture I71.3 Abdominal aortic aneurysm, ruptured I71.4 Abdominal aortic aneurysm, without rupture

13 Cardiovascular Magnetic Resonance (CMR) Page 13 of 16 I71.5 Thoracoabdominal aortic aneurysm, ruptured I71.6 Thoracoabdominal aortic aneurysm, without rupture I71.9 Aortic aneurysm of unspecified site, without rupture I74.11 Embolism and thrombosis of thoracic aorta I79.0 Aneurysm of aorta in diseases classified elsewhere I81 Portal vein thrombosis I82.0 Budd-Chiari syndrome I Acute embolism and thrombosis of inferior vena cava I Chronic embolism and thrombosis of inferior vena cava J86.9 Pyothorax without fistula J90 Pleural effusion, not elsewhere classified J92.0 Pleural plaque with presence of asbestos J92.9 Pleural plaque without asbestos J94.1 Fibrothorax J94.2 Hemothorax J94.8 Other specified pleural conditions K75.1 Phlebitis of portal vein M32.11 Endocarditis in systemic lupus erythematosus M32.12 Pericarditis in systemic lupus erythematosus Q20.0 Common arterial trunk Q20.1 Double outlet right ventricle Q20.2 Double outlet left ventricle Q20.3 Discordant ventriculoarterial connection Q20.4 Double inlet ventricle Q20.5 Discordant atrioventricular connection Q20.6 Isomerism of atrial appendages Q20.8 Other congenital malformations of cardiac chambers and connections Q21.0 Ventricular septal defect Q21.1 Atrial septal defect Q21.2 Atrioventricular septal defect Q21.3 Tetralogy of Fallot Q21.4 Aortopulmonary septal defect Q21.8 Other congenital malformations of cardiac septa Q22.0 Pulmonary valve atresia Q22.1 Congenital pulmonary valve stenosis Q22.2 Congenital pulmonary valve insufficiency Q22.3 Other congenital malformations of pulmonary valve Q22.4 Congenital tricuspid stenosis Q22.5 Ebstein's anomaly Q22.6 Hypoplastic right heart syndrome Q22.8 Other congenital malformations of tricuspid valve Q23.0 Congenital stenosis of aortic valve Q23.1 Congenital insufficiency of aortic valve Q23.2 Congenital mitral stenosis Q23.3 Congenital mitral insufficiency Q23.4 Hypoplastic left heart syndrome Q23.8 Other congenital malformations of aortic and mitral valves Q24.0 Dextrocardia

14 Cardiovascular Magnetic Resonance (CMR) Page 14 of 16 Q24.1 Levocardia Q24.2 Cor triatriatum Q24.3 Pulmonary infundibular stenosis Q24.4 Congenital subaortic stenosis Q24.5 Malformation of coronary vessels Q24.6 Congenital heart block Q24.8 Other specified congenital malformations of heart Q25.0 Patent ductus arteriosus Q25.1 Coarctation of aorta Q25.21 Interruption of aortic arch Q25.29 Other atresia of aorta Q25.3 Supravalvular aortic stenosis Q25.40 Congenital malformation of aorta unspecified Q25.41 Absence and aplasia of aorta Q25.42 Hypoplasia of aorta Q25.43 Congenital aneurysm of aorta Q25.44 Congenital dilation of aorta Q25.45 Double aortic arch Q25.46 Tortuous aortic arch Q25.47 Right aortic arch Q25.48 Anomalous origin of subclavian artery Q25.49 Other congenital malformations of aorta Q25.8 Other congenital malformations of other great arteries Q26.0 Congenital stenosis of vena cava Q26.1 Persistent left superior vena cava Q26.2 Total anomalous pulmonary venous connection Q26.3 Partial anomalous pulmonary venous connection Q26.4 Anomalous pulmonary venous connection, unspecified Q26.8 Other congenital malformations of great veins Q87.40 Marfan's syndrome, unspecified Q Marfan's syndrome with aortic dilation Q Marfan's syndrome with other cardiovascular manifestations Q87.42 Marfan's syndrome with ocular manifestations Q87.43 Marfan's syndrome with skeletal manifestation R09.1 Pleurisy R22.2 Localized swelling, mass and lump, trunk R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation R93.8 Abnormal findings on diagnostic imaging of other specified body structures R94.30 Abnormal result of cardiovascular function study, unspecified R94.31 Abnormal electrocardiogram [ECG] [EKG] T80.0xxA Air embolism following infusion, transfusion and therapeutic injection, initial encounter T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter T81.72xA Complication of vein following a procedure, not elsewhere classified, initial encounter T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounter T82.818A Embolism of vascular prosthetic devices, implants and grafts, initial encounter

15 Cardiovascular Magnetic Resonance (CMR) Page 15 of 16 Z95.5 Presence of coronary angioplasty implant and graft Z98.61 Coronary angioplasty status REVISIONS Effective Effective The Medical Director added to the Policy section "of the coronary arteries", removed "as a screening test" from CV MRI and removed "for diagnosis and screening" from CV MRA for clarification. Policy section was revised to combine information from item F. to B11. Item F. was deleted and stated, "Pulmonary venous assessment in association with atrial fibrillation dysfunctions prior to electro physiology ablation." Item B11 was modified from, "Assessment of pulmonary veins" to its current verbiage. The following paragraph was deleted to remove the definition of class I classification of cardiovascular conditions: "CMR is medically necessary for indications that include an expert Consensus panel's class I classification of cardiovascular conditions. A class I classification is defined as: provides clinically relevant information and is usually appropriate; may be used as first line imaging technique; usually supported by substantial literature." Under "Experimental/investigational indications:" added to number 2, "for diagnosis and screening". Under "Subject to review for medical necessity:" added to number 1, " indications that are not listed above." and deleted, " all indications. Medical records should clearly document medical necessity." A Diagnosis section was added to the policy to reflect all the appropriate diagnoses eligible for this procedure. Previously no diagnoses codes were reflected in the policy. Revision section was added. References were updated In Coding section: Removed CPT Codes: 75552, 75553, 75554, (effective January 1, 2008) Removed CPT Codes: 75558, 75560, 75562, (effective January 2, 2010) Added CPT Codes: 75557, 75558, 75559, 75560, 75561, 75562, 75563, (effective January 1, 2008) Added CPT Code: (effective January 1, 2010) Removed Diagnosis Code: Added Diagnosis Codes: , , 423.3, Added Medical Policy and Coding Disclaimers. In the Policy section: Formatted medical policy language. In Item B, #2, added "of coronary artery disease" to read "Coronary MRA for diagnosis and screening of coronary artery disease" In Coding section: Nomenclature reviewed and updated Policy reviewed. In Coding section: Added ICD-10 Diagnosis codes (Effective October 1, 2014) Updated Reference section In Policy section: In Item B 2 removed "diagnosis and" to read, "Coronary MRA for screening of coronary artery disease." Description section reviewed.

16 Cardiovascular Magnetic Resonance (CMR) Page 16 of 16 In Policy section: In Item A b 5, removed "apical" to read, "Hypertrophic cardiomyopathy" In Item A 4 added a new indication of, "f. Restrictive cardiomyopathy" In Item A 5 b added "or stenosis" to read "Quantification of regurgitation or stenosis" Coding section reviewed References updated Policy reviewed; no changes made Policy reviewed; no changes made In Coding section: Added ICD-10 codes effective : Q25.21, Q25.29, Q25.40, Q25.41, Q25.42, Q25.43, Q25.44, Q25.45, Q25.46, Q25.47, Q25.48, Q25.49 Termed ICD-10 codes effective : Q25.2, Q Policy reviewed; no changes made. REFERENCES 1. Pennell, D.J., Sachem, U.P., Higgins, C.B., et al. (2004). Clinical Indications for Cardiovascular Magnetic Resonance: Consensus Panel Report. Journal of Cardiovascular Magnetic Resonance 6, No.4: Blue Cross and Blue Shield of Kansas Cardiology Liaison Committee, May 2, 2007; May 2013; May 2014; May Blue Cross and Blue Shield of Kansas Medical Advisory Committee (MAC), August 2, 2007.

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