Intra-Arterial/Intravenous Therapeutic Procedures

Section: Surgery
Effective Date: July 01, 2018
Revised Date: January 22, 2020

Description

Vascular surgery involves a traditional surgical approach and a minimally invasive catheter based endovascular approach. These endovascular procedures insert catheters into small incisions in the groin or arms, and are guided through the blood vessels. Endovascular procedures typically have a quicker recovery time and individuals are able to leave the hospital sooner than the traditional open surgical route.

Criteria

ANY ONE of the following intra-arterial/intravenous therapeutic procedures may be considered medically necessary:

  • Transcatheter thrombolytic therapy; or
  • Transcatheter placement of intravascular stents.

Procedure Codes

37211 37212 37213 37214
37236 37237 37238 37239

Arterial percutaneous transluminal angioplasty (PTA) may be considered medically necessary in the treatment of ANY ONE of the following obstructions:

  • Aorta; or
  • Brachiocephalic arteries; or
  • Renal/visceral arteries.

Arterial PTA for any other condition not stated above is considered not medically necessary.

Procedure Codes

36901 36902 36903 36904 36905 36907
36908 36909 37246 37247 37248 37249

Pulmonary PTA may be considered medically necessary for the treatment of obstructions in the pulmonary arteries.

Pulmonary PTA for any other condition not stated above is considered not medically necessary.

Procedure Codes

92997 92998

Venous PTA may be considered medically necessary for the treatment of ANY ONE of the following conditions:

  • On renal patients who have peripheral arterial/venous fistulas for dialysis; or
  • When performed on renal patients who have a centrally placed catheter, i.e., subclavian, jugular, or femoral for dialysis; or
  • When performed for superior vena cava obstruction from benign and malignant diseases; or
  • For central vein stenosis in association with indwelling intravascular devices used for long-term venous access such as central catheters or peripherally inserted central catheters (PICC); or
  • For iliac compression syndrome (for example, May-Thurner Syndrome).

Venous angioplasty when used to remove deep vein thrombosis (DVT) is not considered medically necessary.

Venous PTA for any other condition not stated above is considered not medically necessary.

Procedure Codes

36902 36905 36906 36907 37239
37246 37247 37248 37249

Laser angioplasty for non-coronary vessels is considered experimental/investigational and therefore, non-covered, because scientific evidence does not demonstrate the effectiveness of this procedure.

Procedure Codes

37799

Outpatient HCPCS (C Codes)

C1725 C1874 C1876 C1885 C2625

Diagnosis Codes

Covered Diagnosis codes for procedures codes 37246, 37247, 37248 and 37249

I12.0 I13.11 I13.2 I87.1 N17.0 N17.1 N17.2
N17.8 N17.9 N18.1 N18.2 N18.3 N18.4 N18.5
N18.6 N18.9 N19 T82.49XD T82.818A T82.828A T82.838A
T82.848A T82.858A T82.858D T82.868A T82.898A T82.898D T82.898S
T82.9XXA

Professional Statements and Societal Positions Guidelines

NA

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