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

Percutaneous transluminal angioplasty (PTA) is an eligible procedure in the treatment of the following
obstructions:

• tibioperoneal trunk (37228 and 37232)
• aorta (35472)
• brachiocephalic arteries (35475)
• peripheral arteries (37224)
• renal/visceral arteries (35471)
• iliac (37220 and 37222)

Pre- and post-injections and selective catheter placement for angiography are eligible for separate payment in accordance with multiple surgery guidelines.

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. In this instance, the 59 modifier should be reported in conjunction with the appropriate temporary pacemaker code.

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.

Venous PTA (codes 35460, 35476, 75978) is an eligible procedure when performed 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. In addition, venous PTA is an eligible procedure when performed for superior vena cava obstruction from benign and malignant diseases as well as for the treatment of all central vein stenosis in association with indwelling intravascular devices used for long-term venous access such as central catheters or PIC lines. 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 should be reviewed on an individual consideration basis.

All other conditions will be denied as not medically necessary. They are not covered. A participating, preferred, or network provider cannot bill the member for the denied service unless the provider has given advance written notice, informing the member that the service may be deemed not medically necessary and providing an estimate of the cost. The member must agree in writing to assume financial responsibility, in advance of receiving the service. The signed agreement should be maintained in the provider's records.

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: 02/2010

When ergonovine testing (code 93024) is reported in conjunction with a cardiac catheterization (93451-93453, 93456-93462, 93530-93533), 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. Modifier 59 may be reported with a non-E/M service, to identify it as distinct or independent from other non-E/M services performed on the same day. When modifier 59 is reported, the patient’s records must support its use in accordance with CPT guidelines.

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

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.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

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