HCPCS C9774 is officially defined as "Revascularization, endovascular, open or percutaneous, tibial/peroneal artery(ies); with intravascular lithotripsy and atherectomy, includes angioplasty within the same vessel (s), when performed." HCPCS C9774 is referenced in 8 tracked payer policy changes from BCBS Arizona, Blue Cross Blue Shield of North Dakota, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9774 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross Blue Shield of Arizona has issued a new Evidence-Based Criteria policy (effective 11/01/26) that classifies 62 specific CPT and HCPCS codes as experimental or investigational services and therefore non-covered. This policy applies broadly across multiple specialties and requires billing teams to deny claims for these codes unless members have explicit coverage for experimental services in their benefit plans.
Blue Cross Blue Shield of North Dakota updated multiple medical policies with new covered services, revised criteria, coding changes, and consent policies effective February 19, 2026. Key changes include new procedure codes for prostate treatments, bone density studies, and various other specialties, plus removal of experimental procedure codes.
Percutaneous revascularization using balloon angioplasty, stent procedures, or atherectomy for chronic symptomatic lower extremity peripheral arterial disease may be considered medically necessary when functionally limiting claudication is present, there is an inadequate response to guideline-directed management and therapy including structured exercise, and the potential benefits outweigh the risks and durability of the intervention. These same procedures may also be considered medically necessary for chronic limb-threatening ischemia and for acute limb ischemia, and percutaneous revascularization using lithotripsy is considered investigational in all situations. CPT codes 37220 through 37235 are marked deleted as of 12/31/2025, and CPT codes 37254 through 37299 are marked new as of 01/01/2026.
Blue Cross Blue Shield of North Dakota is restoring several billing codes that were inadvertently removed from their Experimental/Investigational policy in previous months, and adding one new code. Multiple CPT and HCPCS codes are being reinstated for coverage consideration.
Intravascular lithotripsy is considered investigational for all indications. The policy lists CPT 37262, 37279 and 92972 and HCPCS C1761, C7571, C9764, C9765, C9766, C9767, C9772, C9773, C9774 and C9775. The policy is effective January 1, 2026.
Aetna considers peripheral atherectomy of the renal artery, visceral artery, abdominal aorta, and brachiocephalic trunk and branches experimental, investigational, or unproven because its effectiveness has not been established. The same classification applies to the BYCROSS atherectomy device for peripheral arterial disease, intravascular shockwave lithotripsy for the listed peripheral arteries, celiac artery occlusion and renal artery stenosis, and isolated segmental pharmaco-mechanical thrombolysis (Trellis Peripheral Infusion System) for deep venous thrombosis, Paget-Schroetter syndrome, and other indications. Endovascular revascularization codes CPT 37220 through 37247 and 37254 through 37299 and drug-coated balloon catheter code HCPCS C2623 are covered when selection criteria are met, and medical necessity criteria for peripheral atherectomy are set in the EviCore Healthcare Peripheral Vascular Intervention Clinical Guidelines.
The IHCP reviewed the Outpatient Fee Schedule, found discrepancies, and will reflect the changes in the next regular update to that schedule. Codes listed twice on previous versions will appear only once, codes missing from the schedule are covered in the outpatient setting and can be billed for dates of service on or after the date listed for each code, and other listed codes are noncovered and will be added to the schedule. Codes that have been nationally end dated will be removed from the schedule, and Current Dental Terminology (CDT) codes cannot be billed on institutional claims (UB-04 claim form or electronic equivalent).
This Premera medical policy and coding update lists changes from November 2021. Effective November 5, 2021, the Allograft Injection for Degenerative Disc Disease policy 7.01.166 is investigational, and a new Non-covered Experimental/Investigational Services policy 10.01.533 lists services that require investigative review. Effective January 7, 2022, single-level cervical and lumbar spine procedures gained site of service review, and effective February 4, 2022, ASAM codes H0031, H0032, H2014, H2019, S5108, S5109, S5110 and S5111 require medical necessity and prior authorization review for individual plans.
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