echocardiogram and stress echocardiography

Coverage of any medical intervention discussed in a Prevea360 Health Plan medical policy is subject to the limitations and exclusions outlined in the member's benefit

certificate or policy and to applicable state and/or federal laws.

Echocardiogram and Stress Echocardiography 1 of 13 Underwritten by Dean Health Plan, Inc.

Echocardiogram and Stress Echocardiography MP9513

Covered Service: Yes

Prior Authorization Required:

No

Additional Information:

An appropriate diagnosis code must appear on the claim. Claims will deny in the absence of an appropriate diagnosis code.

Prevea360 Health Plan Medical Policy: 1.0 Transthoracic Echocardiography (TTE) does not require prior authorization and is

considered medically necessary for the evaluation of ANY of the following in the appropriate clinical scenario: (not an all-inclusive list): 1.1 Initial evaluation of cardiac structure and function in an asymptomatic member for

ANY of the following: 1.1.1 Evaluation of known systemic, congenital, or acquired disease that could be

associated with a structural heart disease including ANY of the following: 1.1.1.1 Native or prosthetic valvular heart disease and further evaluation is

indicated 1.1.1.2 Abnormalities of the great vessels requiring TTE for evaluation (e.g.

ascending aortic dissection or aneurysm known or suspected) to evaluate acute or chronic aortic pathology

1.1.1.3 Congenital heart disease, known or suspected 1.1.2 Abnormal cardiac testing or finding requires TTE for evaluation (e.g. elevated

troponin, new or worsening murmur, and cardiomegaly on chest x-ray, or left ventricular hypertrophy on electrocardiogram)Screening evaluation for structure and function in first-degree relatives of a member with an inherited cardiomyopathy

1.1.3 Initial evaluation prior to exposure to medications/radiation that could result in cardiotoxicity/heart failure

1.1.4 Evaluation of the ascending aorta in the setting of known or suspected connective tissue disease or genetic condition that predisposes to aortic aneurysm (e.g. Ehlers Danlos or Marfan syndrome)

1.1.5 Screening evaluation in a relative of a member with known aortic aneurysm or dissection




1.1.6 Preparticipation physical assessment of an asymptomatic athlete with one (1) or more of the following: abnormal exam (e.g. new or worsening murmur), abnormal ECG, or definite family history of inheritable heart disease

1.1.7 Evaluation of suspected pulmonary arterial hypertension or other pulmonary condition requiring TTE for evaluation such as pulmonary embolism or hypoxemia

1.1.8 Prosthetic Heart Valves (mechanical and Bio-Prosthesis) to establish a baseline structural and hemodynamic profile

1.2 Initial evaluation of a member with clinical signs and symptoms of heart disease for ANY of the following: 1.2.1 Worsening ventricular function, new, suspected, or worsening

cardiomyopathies or heart failure suspected based on clinical findings (e.g. worsening dyspnea) 1.2.1.1 Unknown etiology of cardiac disease 1.2.1.2 Edema with clinical signs of elevated central venous pressure or

when central venous pressure can’t be estimated 1.2.2 Acute Endocarditis, known or suspected or suspected of acute infective

endocarditis 1.2.3 Arrhythmias or conduction disorders when ANY of the following criteria are

met: 1.2.3.1 Newly diagnosed left bundle branch block (LBBB) 1.2.3.2 Newly diagnosed right bundle branch block (RBBB) 1.2.3.3 Frequent PVC’s without evidence of heart disease 1.2.3.4 Nonsustained ventricular tachycardia (VT) 1.2.3.5 Sustained VT or ventricular fibrillation (VF) 1.2.3.6 Supraventricular tachycardia without other evidence of heart disease

and further evaluation or management (e.g. ablation) is required 1.2.3.7 Atrial fibrillation/flutter

1.2.4 Palpitations/Presyncope/Syncope when ANY of the following criteria are met: 1.2.4.1 Clinical symptoms or signs consistent with a cardiac diagnosis known

to cause presyncope/syncope (e.g. hypertrophic cardiomyopathy and heart failure)

1.2.4.2 Palpitations without other signs or symptoms of cardiovascular disease

1.2.4.3 Syncope without other signs or symptoms of valvular cardiovascular disease or obstructive cardiomyopathy




1.2.4.4 Hypotension or hemodynamic instability of uncertain or suspected cardiac etiology

1.2.4.5 Assessment of volume status in a critically ill member 1.2.5 Initial evaluation of hypertensive cardiovascular disease to evaluate cardiac

effects of systemic hypertension 1.2.6 Acute Myocardial Infarction and Coronary Insufficiency for ANY of the

following: 1.2.6.1 Evaluation of left ventricular function during initial presentation with

acute coronary syndrome 1.2.6.2 Evaluation of regional motion, systolic thickening perturbations and

mural thinning 1.2.6.3 Evaluation of right ventricular ischemia and/or infection 1.2.6.4 Evaluation of chest pain in members with suspected acute myocardial

ischemia, when baseline ECG and other laboratory markers are nondiagnostic and when study can be obtained during pain or within minutes after its abatement

1.2.6.5 Suspected complication of myocardial ischemia/infarction, including but not limited to acute mitral regurgitation, ventricular septal defect, free-wall rupture/tamponade, shock, right ventricular involvement, heart failure, or intraventricular thrombus

1.2.7 Pulmonary: Respiratory failure/exertional shortness of breath/dyspnea or hypoxemia of uncertain etiology to assess right ventricular size and performance, and quantify the severity of pulmonary hypertension

1.2.8 Heart failure/cardiomyopathy for ANY of the following: 1.2.8.1 Initial evaluation of known or suspected heart failure based on

symptoms, signs or abnormal test results to assess systolic or diastolic function and to assess for possible etiology

1.2.8.2 Suspected inherited or acquired cardiomyopathy 1.2.8.3 Evaluation of left ventricular function in members who are scheduled

for or have received chemotherapy 1.2.9 Evaluation of suspected pulmonary hypertension including evaluation of right

ventricular function and estimated pulmonary artery pressure 1.3 Device Therapy: Implantable Cardioverter Defibrillator (ICD), Cardiac

Resynchronization Therapy (CRT) or Left Ventricular Assist Device (LVAD) when ANY of the following criteria are met:




1.3.1 Evaluation after appropriate time following revascularization and/or optimal medical therapy to determine candidacy for ICD/CRT and/or to determine optimal choice of device

1.3.2 Initial evaluation for CRT device optimization after implantation 1.3.3 Known implanted pacing/ICD/CRT device with symptoms possibly due to

suboptimal device settings 1.3.4 To determine candidacy for LVAD 1.3.5 Optimization of LVAD settings

1.4 Cardiac Transplant and Rejection Monitoring when EITHER of the following criteria are met: 1.4.1 Monitoring for rejection or coronary arteriography in a cardiac transplant

recipient 1.4.2 Cardiac structure and function evaluation in a potential heart donor

1.5 TTE is considered medically necessary for other suspected conditions including ANY of the following: 1.5.1 Pericardial Disease

1.5.1.1 Detection of quantification of the amount of pericardial effusion 1.5.1.2 To characterize the hemodynamic consequences of pericardial fluid

accumulation 1.5.1.3 As an adjunct during the removal of pericardial fluid and creation of

pericardial windows 1.5.1.4 Diagnosis of pericardial constriction and differentiating it from

restrictive myocardial disease 1.5.2 Initial evaluation of a cardiac mass, suspected tumor or thrombus, or cardiac

source of an emboli 1.5.3 Suspected acute or chronic aortic pathology including acute aortic syndrome

1.6 Critically Ill and Trauma Patients 1.6.1 Diagnosis of suspect aortic or central pulmonary pathology, cardiac contusion,

or pericardial effusion 1.6.2 Assessment of volume status

1.7 Sequential or follow-up testing: asymptomatic or stable symptoms requiring re-evaluation for ANY of the following: 1.7.1 Re-evaluation (< 1 year) in a member previously or currently undergoing

therapy with potentially cardiotoxic agents




1.7.2 Re-evaluation (≥ 1 year ) of known moderate or greater pulmonary hypertension without change in clinical status or cardiac exam

1.7.3 Re-evaluation of chronic asymptomatic pericardial effusion when findings would potentially alter therapy

1.7.4 Re-evaluation of intracardiac mass when findings would potentially alter therapy

1.8 Sequential or follow-up testing: new or worsening symptoms are present or there is a need to guide therapy and ANY of the following: 1.8.1 Structural heart disease with change in clinical status or cardiac examination

(e.g. new or worsening murmur) or to guide therapy 1.8.2 Known cardiomyopathy with a change in clinical status or cardiac examination

(e.g. new or worsening murmur), or to guide therapy 1.8.3 Known heart failure (systolic or diastolic) with a change in clinical status or

cardiac examination without a clear or precipitating change in medication or diet

1.8.4 Periodic re-evaluation in a member undergoing therapy with cardiotoxic agents and worsening symptoms

1.8.5 After revascularization and/or optimal medical therapy to determine candidacy for device therapy and/or to determine optimal choice of device

1.8.6 Re-evaluation for CRT device optimization in a member with worsening heart failure

1.8.7 Re-evaluation for ventricular assist device related complications or infection is suspected

1.8.8 Progression of pericardial effusion size or development of tamponade 1.8.9 Progression of pericardial constriction 1.8.10 Member with pericardial mass and symptoms suggestive of expansion 1.8.11 Re-evaluation of known ascending aortic dilatation or history of aortic

dissection with a change in clinical status 1.8.12 Known pulmonary hypertension with change in clinical status or cardiac

examination or to guide therapy 1.9 Evaluation of TIA or ischemic stroke and ANY of the following criteria are met:

1.9.1 Initial evaluation of member to exclude cardiac origin of TIA or ischemic stroke (e.g. intracardiac masses or valvular pathology)

1.9.2 To assess for the presence of right-to-left intracardiac shunt (e.g. with provocative maneuvers, Valsalva cough)




1.10 Preprocedural evaluation for closure of patent foramen ovale (PFO) or atrial septal defect (ASD) and ANY of the following: 1.10.1 Preprocedural evaluation of the following: atrial appendage thrombus,

spontaneous echo contrast, cardiac masses or vegetations 1.10.2 Preprocedural assessment of atrial septum anatomy or atrial septal aneurysm

is required, or to evaluate suitability for percutaneous device closure 1.10.3 TTE needed following closure of PFO or ASD for ANY of the following:

1.10.3.1 Six (6)-month routine scheduled follow-up after device closure for position of device and integrity

1.10.3.2 Non-routine follow-up of device closure and clinical concern for infection, malposition, embolization or persistent shunt

1.11 Preprocedural evaluation for closure of Left Atrial Appendage (LAA) for EITHER of the following: 1.11.1 Pre-procedural evaluation of the following: all cardiac chambers, LV function,

interatrial septum, and valve function 1.11.2 Intra-procedural guidance to screen for procedural complications

1.12 Non-contrast echocardiography has been performed and TTE is required for additional evaluation

2.0 TTE is considered not medically necessary and therefore not covered for ANY of the following indications including but not limited to: 2.1 Performed for screening purposes 2.2 Initial evaluation of member with suspected pulmonary embolism in order to

establish diagnosis 2.3 Members who have isolated Atrial Premature Complex or Premature Ventricular

Contraction without evidence of heart disease 2.4 Evaluation of left Ventricular function with prior ventricular function withing the past

year with normal echocardiogram, left ventriculogram, Single Photo Emission Computed Tomography (SPECT), or cardiac MRI in members in whom there has been no change in clinical status

2.5 Evaluation of native and/or prosthetic valves in members with transient fever but without evidence of bacteremia

2.6 Evaluation of member with atrial fibrillation/flutter to left atrial thrombus or spontaneous contrast when a decision has been made to anticoagulated and not to perform cardioversion

2.7 Routine evaluation is considered not medically necessary for ANY of the following:




2.7.1 Asymptomatic members with corrected Atrial Septal Defect, Ventricular Septal Defect, or Patent Ductus Arteriosus more than one year after successful correction

2.7.2 Member with a prosthetic valve in whom there is no suspicion of valvular dysfunction and no change in clinical-status

2.7.3 Hypertrophic cardiomyopathy in a member with no change in clinical status 2.7.4 Members with systemic hypertension without suspected hypertensive heart

disease 2.8 Routine re-evaluation is considered not medically necessary for ANY of the

following: 2.8.1 Mitral valve prolapse in members with no or mild mitral regurgitation and no

change in clinical status 2.8.2 Native valvular regurgitation in an asymptomatic member with mild

regurgitation, no change in clinical status and normal left ventricular size 2.8.3 Asymptomatic member with native aortic stenosis or mild-moderate native

mitral stenosis and no change in clinical status 2.8.4 Member with known hypertensive heart disease without a change in clinical

status 2.8.5 Member with heart failure (systolic or diastolic) in whom there is no change in

clinical status 3.0 Transesophageal Echocardiography (TEE) does not require prior authorization and is

considered medically necessary for ANY of the following, in the appropriate clinical scenario (not an all-inclusive list): 3.1 Endocarditis:

3.1.1 Suspicion of endocarditis is high and TTE does not document endocarditis 3.1.2 Re-evaluation in complex endocarditis 3.1.3 Evaluation of bacteremia without known source 3.1.4 Evaluation of suspected or actual prosthetic valve endocarditis otherwise;

obscured because of reverberations and other image artifacts related to mechanical or other non-native valves during TTE

3.2 Valvular Prostheses: For the evaluation of suspected prosthetic valve (mechanical and bioprosthesis) dysfunction when therapeutic decisions are critical and TTE is inconclusive and/or when the left atrium must be well-visualized.

3.3 Suspected complication of myocardial ischemia/infarction, including mitral regurgitation

3.4 Cardiac/Pericardial Masses and Other Pericardial Disease:




3.4.1 Visualization of left atrial masses when needed to provide therapeutic direction 3.4.2 When cardiac mass lesions (including tumors on cardiac valves) are suspect

and cannot be visualized on TTE 3.4.3 To assess pericardial effusion when surface studies do not provide adequate

information 3.5 Suspected Cardiac Thrombi and Emboli:

3.5.1 Left atrium and atrial appendage for clots, when clot is not visualized on TTE; 3.5.2 ASD, patent foramen ovale or atrial septal aneurysm with clot 3.5.3 Evaluation of the mitral valve in members with a history of emboli

3.6 Aortic Pathological Conditions and Disease of the Great Vessels: 3.6.1 Aortic root which is not sufficient with TTE 3.6.2 Identification of acute aortic syndrome, aortic ulceration, aortic dissection,

atherosclerotic plaque, mural thrombotic material or aortic transection 3.6.3 Descending thoracic aorta for aneurysms 3.6.4 Superior vena cava and diagnose various congenital and acquired

abnormalities 3.6.5 Proximal inferior vena cava, vena caval dilation, and detection of thrombosis

or extension of tumors from the inferior vena cava to the right-heart chambers 3.6.6 Four pulmonary veins 3.6.7 Evaluation of the heart and great vessels following blunt trauma to the chest 3.6.8 To assist in decision making prior to aortic valve operative intervention 3.6.9 Congenital Heart Disease: TEE is considered medically necessary for ANY of

the following: 3.6.9.1 Postoperatively where fibrosis, echo opaque patches and prostheses,

inadequate penetration, and acoustical shadowing can result in incomplete TTE data

3.6.9.2 TEE is technically inadequate or anatomic definition is incomplete 3.6.9.3 Members in whom a more precise definition of atrial outflow tract and

proximal pulmonary vascular anomalies is critical to management 3.6.9.4 To assess complications of congenital heart surgery, visualization of

shunt flow across atrial-septal defects, guidance of clamshell device to close atrial-septal defects, diagnosis of cor triatriatum, and detection of pulmonary valve abnormalities

3.7 Comprehensive evaluation of dilated aortic sinuses or ascending aorta identified on TTE and TTE is not sufficient




3.8 Evaluation of the aortic sinuses, sinotubular junction, or ascending aorta in members with bicuspid aortic valve when morphology can’t be assessed accurately by TTE

3.9 Re-evaluation of intracardiac mass when findings would potentially alter therapy 3.10 Re-evaluation of prior TEE findings for interval change (e.g. reduction or resolution

of atrial thrombus after anticoagulation, or intracardiac evaluation of a cardiac mass) 3.11 Re-evaluation for ventricular assist device-related complication or when infection is

suspected 3.12 Re-evaluation of known ascending aortic dilatation or history of aortic dissection with

a change in clinical status or cardiac examination 3.13 Evaluation of TIA or ischemic stroke for ANY of the following:

3.13.1 Initial evaluation of member to exclude cardiac origin of TIA or ischemic stroke, such as intracardiac masses or valvular pathology

3.13.2 To assess for the presence of right-to-left intracardiac shunt such as with provocative maneuvers (e.g. Valsalva cough)

3.14 Preprocedural evaluation for closure of patent foramen ovale (PFO) or atrial septal defect (ASD) and ANY of the following criteria are met: 3.14.1 Preprocedural evaluation for ANY of the following: atrial appendage thrombus,

spontaneous echo contrast, cardiac masses or vegetations 3.14.2 Preprocedural assessment of atrial septum anatomy or atrial septal aneurysm

is required, or to evaluate suitability for percutaneous device closure 3.14.3 Intra procedural guidance for closure device of PFO or ASD 3.14.4 Non routine follow-up of PFO or ASD device closure and concern for infection,

malposition, embolization or persistent shunt 3.15 Preprocedural evaluation for closure of Left Atrial Appendage (LAA) for ANY of the

following: 3.15.1 Pre-procedural evaluation of cardiac structures and valve function 3.15.2 To select or guide delivery and deployment of LAA closure device 3.15.3 To screen for procedural complications and assess adequacy of LAA

occlusion 3.15.4 Following LAA occlusion surveillance at 45 days or as per FDA

guidance/guidelines for follow-up to assess stability: exclude migration, displacement, or erosion; assess device leak

3.16 Interventional and Surgical: 3.16.1 Guidance during percutaneous interventions 3.16.2 Intraoperative evaluation to assess prosthetic or repaired/reconstructed valve

function or integrity of complex congenital heart disease, during heart-lung




transplants, and assess the presence or severity of outflow tract obstruction or presence/repair of an intracardiac shunt

3.17 Mitral Valve Disease: 3.17.1 To assess the etiology of mitral regurgitation 3.17.2 Valvular heart disease as indicated by mitral regurgitation (chronic and

primary) to guide the choice between a valve repair or replacement 3.18 TTE is technically inadequate, anatomic definition is incomplete, nondiagnostic TTE,

or high likelihood of nondiagnostic TTE 3.19 Pericardial disease, known or suspected 3.20 Postprocedural evaluation of members with congenital heart disease 3.21 Critically ill members when TTE is contraindicated, members with persistent

hypoxemia having suspected right-to-left shunt, complications of myocardial infarction, hemodynamically unstable or brain-dead member being considered as a cardiac donor

3.22 Cardioversion: 3.22.1 Urgent cardioversion for whom pre-cardioversion anticoagulation is not

desirable 3.22.2 Prior cardioembolic events thought to be related to intra-atrial thrombus 3.22.3 Anticoagulation is contraindicated and for whom a decision about

cardioversion will be influenced by TEE results 3.22.4 Intra-atrial thrombus has been demonstrated in previous TEE

4.0 Fetal Echocardiogram does not require prior authorization and is considered medically necessary for ANY of the following in the appropriate clinical scenario: (not an all-inclusive list): 4.1 Abnormal or incomplete cardiac evaluation 4.2 Complex congenital heart disease 4.3 Suspected fetal chromosomal abnormalities 4.4 Members with familial inherited disorders 4.5 Member’s mother has insulin dependent diabetes mellitus and fetal echocardiogram

is clinically indicated 5.0 The use of TTE, TEE or fetal echocardiogram is considered not medically necessary and

therefore not a covered service when criteria have not been met, or when performed for other indications, including but not limited to the following: 5.1 Unspecified chest pain, in the absence of a condition or finding which would indicate

potential structural heart disease




5.2 Atherosclerotic heart disease of native coronary artery, without angina pectoris 5.3 Nonrheumatic mitral valve insufficiency 5.4 Patent ductus arteriosus 5.5 Supraventricular tachycardia, in the absence of a condition or finding which would

indicate potential structural heart disease 5.6 TEE is considered not medically necessary for the following:

5.6.1 Screening examinations to identify structural cardiac abnormalities in the absence of established diagnosis or without signs or symptom

5.6.2 Serial assessment and management of pericardial pathology 6.0 Stress Echocardiography does not require prior authorization and is considered

medically necessary for ANY of the following, when the member is able to exercise and in the appropriate clinical scenario (not an all-inclusive list): 6.1 Exertional SOB/dyspnea or hypoxemia of uncertain etiology 6.2 Initial evaluation of known or suspected heart failure based on signs or symptoms or

abnormal test 6.3 Left ventricular systolic dysfunction in the absence of severe valvular disease 6.4 Excluding coronary artery disease in a member with heart failure of left ventricular

dysfunction without angina 6.5 Evaluation of suspected hypertrophic cardiomyopathy 6.6 To detect coronary artery disease in members presenting with chest pains including

atypical chest pains and exertional dyspnea when the suspicion for CAD is high when ALL of the following criteria are met: 6.6.1 Cardiac risk factors present (e.g. diabetes mellitus, history of heart failure,

family history of coronary artery disease); AND 6.6.2 Abnormal ECG non-diagnostic; AND 6.6.3 Negative or minimally elevated cardiac biomarkers; AND 6.6.4 No ongoing chest pain

6.7 Chest pain in members suspected of angina when exercise treadmill testing alone would be unreliable or inconclusive

6.8 To assess prognosis and functional capacity in members following an acute myocardial infarction

6.9 To evaluate the extent of exercise induced ischemia in members who have had revascularization procedures

6.10 To evaluate prior nondiagnostic or abnormal ECG exercise test as a substitute for a nuclear perfusion study




6.11 To evaluate members who are at high risk for myocardial infarction prior to a scheduled major surgical or transplant procedure

6.12 Arrythmia (atrial and/or ventricular) or Syncope: To evaluate, such as sustained or non-sustained ventricular tachycardia, or in new-onset atrial or supraventricular arrhythmia when the member is at moderate or high risk of coronary artery disease

6.13 To evaluate members when an indicated standard exercise ECG is likely to be non-diagnostic

6.14 To assess myocardial viability for planned revascularization or functional significance of coronary lesions in planning percutaneous

6.15 To evaluate cardiomyopathy when the evaluation could reasonably be expected to contribute significant information regarding the member’s condition or treatment plan

6.16 To evaluate ventricular dysfunction due to post-transplant rejection 6.17 Need for testing in the course of cardiac rehabilitation 6.18 Congenital heart disease when heart stress echocardiography helps determine

systemic and right ventricular function at rest and following stress and the presence of any other structural abnormalities

6.19 Coronary artery disease (CAD) in the appropriate clinical scenario (e.g. previous revascularization or medical treatment of CAD), when exercise treadmill testing alone would be unreliable

6.20 Cardiac evaluation of diabetic members in the appropriate clinical scenario 6.21 Cardiomyopathy in members with heart failure, ventricular dysfunction or

cardiomyopathy 6.22 Preoperative cardiovascular evaluation in the appropriate clinical scenario 6.23 Syncope when exercise treadmill testing alone would be unreliable or inconclusive 6.24 Valvular heart disease evaluation is required and clinically appropriate 6.25 History of heart failure or worsening heart failure 6.26 Left ventricular hypertrophy or ventricular dysfunction 6.27 Hypertrophic cardiomyopathy, known, and need for dynamic assessment 6.28 Ventricular dysfunction as indicated by cardiomyopathy evaluation needed or

member unable to exercise 7.0 The use of Stress Echocardiography is considered not medically necessary and

therefore not a covered service when the criteria in (1.0) TTE has not been met, or when performed for other indications, including but not limited to the following: 7.1 Unspecified chest pain, in the absence of a condition or finding which would indicate

potential structural heart disease 7.2 Patent ductus arteriosus




7.3 Screening test for ischemic heart disease in a member without signs or symptoms 8.0 3-Dimensional Echocardiography does not require prior authorization and is

medically necessary for ANY of the following: 8.1.1 Pre-operative planning in members who will be having surgery to repair mitral

valve prolapse 8.1.2 Monitoring the mitral valve area in members with moderate to severe mitral

stenosis

Committee/Source Date(s) Document Created:

Medical Policy Committee/Quality and Care Management Division

January 10, 2018

Revised: Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division

February 20, 2019 October 16, 2019 February 19, 2020 October 20, 2021

Reviewed: Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division Medical Policy Committee/Health Services Division

February 20, 2019 October 16, 2019 February 19, 2020 February 17, 2021 October 20, 2021

Published/Effective: 12/01/2021

echocardiogram and stress echocardiography

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