Publication Number

100-3

Manual Section Number

20.24

Version Number

1

Effective Date of this Version

10/12/1988

Benefit Category

Diagnostic Tests (other)

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

Displacement cardiography, including cardiokymography and photokymography, is a noninvasive diagnostic test used in evaluating coronary artery disease.

Indications and Limitations of Coverage

A - Cardiokymography

Cardiokymography is covered for services rendered on or after October 12, 1988.

Cardiokymography is a covered service only when it is used as an adjunct to electrocardiographic stress testing in evaluating coronary artery disease and only when the following clinical indications are present:

• For male patients, atypical angina pectoris or nonischemic chest pain; or
• For female patients, angina, either typical or atypical.

B - Photokymography - Not Covered

Photokymography remains excluded from coverage.

Transmittal Number

33

Revision History

09/1988 - Cardiokymography covered for certain indications. Photokymography remained noncovered. Effective date 10/12/1988. (TN 33)

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