CMS Hemorheograph Form

Effective Date

01/01/2066

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

The hemorheograph is a diagnostic instrument which is safe and effective for determining the adequacy of skin perfusion prior to the performance of minor surgical procedures on the extremities, including minor podiatric procedures, and as an adjunct to the evaluation of patients suspected of having peripheral vascular disease.

Program payment may be made only for those services employing the hemorheograph which are performed for preoperative and postoperative diagnostic evaluation of suspected peripheral artery disease.

NOTE: This instrument is not a plethysmograph and is not considered as such. A plethysmograph measures and records changes in the size of a body part as modified by the circulation of blood in that part. The hemorheograph, on the other hand, measures surface blood flow in the skin; it does not measure total blood flow in a digit or limb.