These intra-arterial therapeutic procedures are eligible for payment except as noted:

1. Percutaneous transluminal angioplasty (PTA)(35470-35475)
   
   

   1. PTA is an eligible procedure in the treatment of obstructions in the tibioperoneal trunk, the aorta, the brachiocephalic arteries, the peripheral arteries and the renal/visceral arteries. Pre- and post-injections and selective catheter placement for angiography are eligible for separate payment in accordance with multiple surgery guidelines.

   2. Percutaneous transluminal coronary angioplasty (PTCA), including laser and/or balloon techniques (codes 92982, 92984), is an eligible procedure for the treatment of obstructions in the coronary arteries. Cardiac catheterization and pre- and post-injections for angiographic studies are eligible for separate payment in accordance with multiple surgery guidelines.
      
      

      In accordance with Medical Policy Bulletin G-10, payment may be made for medical care in addition to PTCA.

      Furthermore, payment can be made at 50% for the insertion of a temporary pacemaker (33210, 33211) when performed in conjunction with PTCA.

   3. Pulmonary PTA (codes 92997, 92998) is an eligible procedure for the treatment of obstructions in the pulmonary arteries. In addition, cardiac catheterization and pre- and post-injections for angiographic studies are eligible for separate payment in accordance with multiple surgery guidelines.

   4. Venous PTA (codes 35460, 35476, 75978) is an eligible procedure when performed on renal patients who have peripheral arterial/venous fistulas for dialysis (403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 584.5-584.9, 585, 585.1-585.9, 586, 996.73). In addition, venous PTA is an eligible procedure when performed for superior vena cava obstruction from benign and malignant diseases. Pre- and post-injections and selective catheter placement for angiographic studies are eligible for separate payment in accordance with multiple surgery guidelines.

      Venous PTA for the treatment of congenital heart disease (746.00-746.09, 746.1-746.7, 746.81-746.89, 746.9) should be reviewed on an individual consideration basis.

      NOTE:

      See Medical Policy Bulletin S-108 for guidelines on venous PTA when it is performed as part of the TIPS procedure.

      
      

      All other conditions are considered experimental/investigational. They are not covered. Scientific evidence does not demonstrate the effectiveness of this procedure for other conditions. In addition, there are no long-term studies available.
      
      Date Last Reviewed: 03/2006

   5. Laser angioplasty for non-coronary vessels is considered experimental/investigational. It is not covered because scientific evidence does not demonstrate the effectiveness of this procedure.
      
      Date Last Reviewed: 04/2006
      
   
   
2. When ergonovine testing (code 93024) is reported in conjunction with a cardiac catheterization (93510-93533), only the cardiac catheterization will be paid. Ergonovine testing is considered an integral part of the cardiac catheterization. It is not eligible as a distinct and separate service. If ergonovine testing is reported on the same day as cardiac catheterization, and the charges are itemized, combine the charges and pay only the cardiac catheterization.  Payment for the cardiac catheterization performed on the same date of service includes the allowance for the ergonovine testing.  A participating, preferred, or network provider cannot bill the member separately for the ergonovine testing in this case.
   
   

   If the ergonovine testing is performed independently, process it under procedure code 93024.

For information on intravascular ultrasound, see Medical Policy Bulletin S-115.

For guidelines on arterial puncture hemostasis or closure required after the removal of the catheter (e.g., Angio-Seal), see Medical Policy Bulletin S-20.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Under the Federal Employee Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. Venous PTA for conditions other than renal patients who have peripheral fistulas for dialysis is considered an eligible service when determined medically necessary based on the patient’s condition.

PRN References

03/1995, Venous transluminal balloon angioplasty
08/1996, Coronary laser angioplasty
08/1997, Venous transluminal balloon angioplasty eligibility rules changes
04/2002, Blue Shield allows separate payment for certain cardiac procedures
06/2004, Venous transluminal balloon angioplasty