61645 Insurance Policy Changes

CPT 61645, in plain terms, covers Percutaneous mechanical clot removal, thrombolytic infusion, or both in an intracranial artery, including diagnostic angiography, fluoroscopic guidance, and catheter placement. CPT 61645 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 61645 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 61645 on AAPC

Aetna · Identified Oct 18, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-10-14)
Aetna's Cerebral Perfusion Studies policy (CPB 0663) sets when CT and MRI perfusion studies of the brain are medically necessary. CT perfusion is covered for evaluating acute stroke (less than 24 hours) including hemorrhagic stroke, transient ischemic attacks, follow-up of cerebral ischemia or infarction, planning and evaluating therapy for arterial occlusive disease, identifying cerebral hyperperfusion syndrome after revascularization, and evaluating the vascular status of solid tumors where MRI is degraded by susceptibility artifact. MRI perfusion is covered for diagnosing and following mass lesions such as glioma, and for assessing acute stroke penumbra, hemodynamic significance of cervical or intracranial stenosis, revascularization efficacy and vasospasm. The policy lists many other uses as experimental, investigational or unproven, including CT perfusion for confirmation of brain death, evaluation of head trauma, and evaluation of vasospasm after aneurysmal subarachnoid hemorrhage.
Aetna · Identified Aug 15, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)
Aetna considers CT perfusion studies of the brain medically necessary for evaluating acute stroke (less than 24 hours), including hemorrhagic stroke, subdural hemorrhage and transient ischemic attacks, for following up cerebral ischemia or infarction, for planning therapy for cervical or intracranial arterial occlusive disease, for identifying cerebral hyperperfusion after revascularization, and for evaluating the vascular status of solid tumors when MRI is degraded by susceptibility artifact. Aetna considers MRI perfusion studies medically necessary for diagnosing and following mass lesions such as glioma, for assessing acute stroke penumbra, and for assessing the hemodynamic significance of cervical or intracranial vascular stenosis and the efficacy of revascularization. Aetna considers CT perfusion experimental, investigational or unproven for indications including confirmation of brain death, differentiation of lung cancer from benign lesions, evaluation of head trauma and evaluation of cerebral vasospasm, and considers MRI perfusion unproven for indications including evaluation of traumatic brain injury, evaluation of persistent pain and prognostication of obstructive sleep apnea.
Aetna · Identified Aug 14, 2026Medium impact
Acute Ischemic Stroke Treatments (CPB 0789, reviewed 2025-11-19)
Endovascular therapy with a retrievable stent is medically necessary for acute ischemic stroke with occlusion of the middle cerebral artery trunk or its branches, or the internal carotid artery, when salvageable tissue is shown on imaging and retrieval is performed within 12 hours after stroke onset. Intra-arterial infusion of spasmolytics such as papaverine, or calcium-channel blockers such as nicardipine, into intracranial arteries is medically necessary only for medically refractory symptomatic delayed cerebral ischemia (cerebral vasospasm) after aneurysmal subarachnoid hemorrhage, and is experimental, investigational, or unproven for all other indications. Acute stenting with concomitant tirofiban, cerebrolysin, defibrinogen therapy, erythropoietin, hypothermia, transcranial ultrasound such as the CLOTBUST-HF device, sphenopalatine ganglion stimulation, statins, and vagus nerve stimulation for myocardial atrophy after AIS are experimental, investigational, or unproven, along with several other listed therapies.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
Intracranial stent placement may be considered medically necessary as part of endovascular treatment of intracranial aneurysms when surgical treatment is not appropriate and standard endovascular techniques do not allow complete isolation of the aneurysm, such as a wide-neck aneurysm of 4 mm or more or a sack-to-neck ratio less than 2:1. Intracranial percutaneous transluminal angioplasty with or without stenting is considered investigational in the treatment of atherosclerotic cerebrovascular disease. The most recent update dated 08/31/2026 updated the policy description and policy guidelines with minor changes, with policy statements unchanged.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 61645?

CalViva Health lists 61645 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 61645?

Community Health Plan of Imperial Valley lists 61645 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 61645?

There are 4 tracked policy changes affecting CPT 61645, including updates from Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 61645?

Payers that have issued tracked updates for CPT 61645 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 61645 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 61645. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 61645?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 61645 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Cerebral Perfusion Studies (CPB 0663, reviewed 2026-10-14)

Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

Acute Ischemic Stroke Treatments (CPB 0789, reviewed 2025-11-19)

Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

Prior authorization required