Cardiac Catheterization — Humana MA

Score

95.2

Pass · 3m 01s

Criteria

Correctly identified cardiac indication from stress test1.0

Accounted for renal function in contrast planning0.9

Medicare Advantage requirements addressed1.0

Authorization obtained1.0

Patient

Dorothy Adams, 72F

Primary Dx

I25.10 — CAD

Payer

Humana Medicare Advantage

Procedure

CPT 93458 — Cath

eGFR

48 mL/min (CKD 3)

BMI

24.1

Changes made by agent

Auth StatusNone→Approved (HUM-2026-0087341)

Auth Expiry—→2026-07-15 (90 days)

Agent Activity

0:00

Read patient chart

Accessed cardiac history, stress test results, medication list, renal function labs.

0:18

Reviewed stress test findings

Positive stress test showing ischemia in LAD territory. Cardiology recommends diagnostic catheterization.

0:45

Checked Medicare Advantage requirements

Queried Humana MA prior auth rules. Requires positive stress test or equivalent indication.

1:30

Composed clinical summary

Documented cardiac history, stress test findings, medication list, and procedural indication with contrast precautions for CKD.

2:15

Submitted to payer

Submitted via Humana portal with full clinical package.

3:01

Authorization received

Auth #HUM-2026-0087341 approved for diagnostic catheterization.