CMS Displacement Cardiography Form
Procedure is not covered
Background for this Policy
Displacement cardiography, including cardiokymography and photokymography, is a noninvasive diagnostic test used in evaluating coronary artery disease.
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.