Are there coverage requirements for payment of LUMASON® (sulfur hexafluoride lipid-type A microspheres) for injectable suspension?
Most payers, including Medicare contractors, have specific coverage requirements for echocardiography with contrast. Therefore, you would have to meet the coverage requirements for echocardiography with contrast before LUMASON would be paid.
Most of the available policies state that contrast echocardiography is allowed when a non-contrast echo has been performed and documented as sup-optimal images as defined by ASE guidelines1 when 2 or more contiguous left endocardial segments in any given apical views were not seen and this information would be necessary to determine appropriate management of the patient.
Check your payer website for coverage policies. Medicare coverage policies and articles can be searched at https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx.
Porter et al. Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2014;27:797-810