Coverage

The Centers for Medicare and Medicaid Services (CMS) provides coverage for Esophageal Doppler Monitoring (EDM) under section 220.5 of the National Coverage Determination (NCD) Ultrasound Diagnostic Procedures. CMS determined that EDM is “reasonable and necessary” for all Medicare beneficiaries who meet the criteria for the following patient populations:

• Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU; and
• Operative patients with a need for intra-operative fluid optimization

CMS’s decision was based in part on a technology assessment from the Agency for Healthcare Research and Quality (AHRQ) which concluded that in “patients undergoing surgical procedures with an expected substantial blood loss or fluid compartment shifts requiring fluid replacement” the clinical evidence for the use of EDM in the above patient populations was strong.

Disclaimer: This information is provided by Deltex Medical as a guide for coding procedures and services involving Esophageal Doppler Monitoring. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers in accurately obtaining coverage and reimbursement for their health care services. Deltex makes no express or implied warranty or guarantee (i) that the list of codes and narratives is complete or error-free, (ii) that the use of this information will prevent differences of opinions or disputes with payers, (iii) that these codes will be covered, or (iv) that the provider will be guaranteed reimbursement. Providers assume full responsibility for all reimbursement decisions or actions. We strongly suggest you consult your payer organizations with regard to coverage and reimbursement policies.