Cardiac Stress Testing - MEDICAID - SOUTH CAROLINA (New)
Effective date
Aug 26, 2026
Identified
Aug 25, 2026
Summary
Humana Medicaid members in South Carolina may be eligible for cardiac stress testing with CPT 78466, 78468 and 78469 and HCPCS A9611 (flurpiridaz F-18) for the listed indications, under a policy effective August 26, 2026. Covered indications include symptomatic known or suspected coronary artery disease, newly diagnosed heart failure or cardiomyopathy, evaluation after PCI or CABG with new or recurrent symptoms suggestive of myocardial ischemia, assessment of myocardial viability, cardiac risk stratification before oncologic therapy, and chronic chest pain evaluation. Coverage requires the absence of all of the following: acute myocardial infarction, high-risk unstable angina, and pregnancy.
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01Already effective August 26, 2026: Billing team: Before billing CPT 78466, 78468, 78469 or HCPCS A9611 for a South Carolina Medicaid member, confirm the member's indication matches one of the listed indications and confirm that acute myocardial infarction, high-risk unstable angina and pregnancy are absent.
02For members under age 21, requests are reviewed for medical necessity under EPSDT requirements.
03Do not rely on the listed codes alone, because inclusion of a code does not guarantee coverage or reimbursement for a service or procedure.
Codes mentioned
784667846878469A9611
Original notice
Cardiac Stress Testing - MEDICAID - SOUTH CAROLINA (New)
mcp.humana.com · Always check the source before changing claims.
Summaries are AI-assisted. Always confirm against the original payer notice.
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