CMS Displacement Cardiography Coverage Policy Update (NCD 262): What Billing Teams Need to Know

CMS has issued a modification to National Coverage Determination (NCD) 262, which governs displacement cardiography—a category of noninvasive cardiac diagnostic testing that includes both cardiokymography and photokymography. If your cardiology or internal medicine practice bills for stress testing adjuncts, this policy directly affects which patients qualify for covered services and which procedures remain excluded from Medicare reimbursement. Understanding the specific clinical criteria is the difference between a clean claim and a denial.

What Is Displacement Cardiography Under CMS NCD 262?

Displacement cardiography is a category of noninvasive diagnostic testing used to evaluate coronary artery disease (CAD). Under NCD 262, CMS recognizes two modalities within this category:

• Cardiokymography — a technique that measures cardiac wall motion
• Photokymography — an optical-based variant of the same concept

These tests fall under the Medicare benefit category of Diagnostic Tests (other). The policy's modification reinforces long-standing coverage distinctions between these two modalities that billing teams must apply correctly at the claim level.

CMS Cardiokymography Coverage Criteria: Who Qualifies?

Cardiokymography is a covered Medicare service, but only within tightly defined parameters. Billing outside these boundaries will result in a medical necessity denial.

Coverage requires all three of the following conditions:

That third condition is where most billing errors occur. CMS specifies different clinical thresholds for male and female patients.

Sex-Specific Indications for Cardiokymography Coverage

This distinction matters significantly in documentation. A male patient presenting with typical angina does not meet the coverage criteria under this NCD. A female patient with atypical angina does. Before submitting any claim for cardiokymography, your billing team must confirm the documented diagnosis aligns with the correct patient-specific indication.

The policy is explicit: cardiokymography covered outside of EKG stress testing—or without the appropriate clinical indication—does not meet medical necessity under Medicare.

Photokymography: Still Not Covered Under CMS Policy

Photokymography remains explicitly excluded from Medicare coverage under NCD 262. This is not a new development—the exclusion has been in place—but the modification reaffirms it, which is worth noting for any team that may have questioned whether this had changed.

There is no pathway for medical necessity exceptions or prior authorization approvals for photokymography under this NCD. Any claim submitted for photokymography as a Medicare service will be denied. If your practice has been exploring this modality, patient financial counseling and advance beneficiary notice (ABN) protocols are essential before the service is rendered.

Affected Codes

The policy document for NCD 262 does not list specific CPT or HCPCS codes for displacement cardiography services. CMS notes that claims processing instructions apply, which means local Medicare Administrative Contractors (MACs) may have additional guidance on how to code these services at the claim level.

Covered Procedures (Subject to Clinical Criteria)

Non-Covered Procedures

Related ICD-10 Diagnosis Codes

The policy does not list specific ICD-10-CM codes. However, based on the covered clinical indications, your team should ensure documentation supports diagnoses consistent with the following presentations:

Contact your MAC or refer to your encoder for the specific ICD-10-CM codes that map to these clinical presentations in your patient population.

What Your Billing Team Should Do