I65.21 Insurance Policy Changes

ICD-10 I65.21 is officially defined as "Occlusion and stenosis of right carotid artery." code I65.21 is referenced in 7 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I65.21 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Dec 18, 2025Medium impact
Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110
Excellus BlueCross BlueShield medical policy 7.01.110 considers carotid angioplasty with or without stenting, by transfemoral or transcarotid artery revascularization (TCAR), medically necessary for symptomatic patients with greater than 50% carotid artery stenosis who are at risk for adverse outcomes during carotid endarterectomy, and for asymptomatic patients with greater than 70% stenosis of the common or internal artery who are at similar risk. It considers other carotid indications, extracranial vertebral artery angioplasty or stenting, and intracranial angioplasty with or without stenting for intracranial atherosclerotic stenosis investigational. The current effective date is December 18, 2025, and the December 18, 2025 annual review states that policy intent is unchanged.
Aetna · Identified Oct 1, 2026Medium impact
Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures (CPB 0276, reviewed 2026-09-10)
Aetna considers angioplasty with carotid stenting medically necessary when an FDA-approved carotid stent and an FDA-approved or cleared embolic protection device are used for symptomatic carotid stenosis of at least 50% or asymptomatic stenosis of at least 70%, with duplex ultrasound as first-line evaluation, CTA or MRA confirmation when not contraindicated, and neurological assessment before and after stenting. Carotid endarterectomy is considered medically necessary for asymptomatic stenosis greater than 70% or symptomatic stenosis greater than 50%, and endovascular repair of intracranial aneurysms using stent-assisted coiling or flow diverting stents is also considered medically necessary. Intracranial angioplasty is considered medically necessary for medically refractory symptomatic delayed cerebral ischemia (cerebral vasospasm) after aneurysmal subarachnoid hemorrhage, while carotid revascularization is considered not medically necessary for members with a disabling stroke (modified Rankin scale 3 or greater), and extracranial vertebral stenting for asymptomatic stenosis, drug-eluting stents for extracranial artery stenosis, intracranial angioplasty and stenting for atherosclerotic stenosis, emergent large artery occlusion and all other indications, and permanent common carotid embolic protection devices are considered experimental, investigational or unproven.
Aetna · Identified Oct 1, 2026Medium impact
Drug-Eluting Stents (CPB 0621, reviewed 2026-09-23)
Aetna considers FDA-approved everolimus-, paclitaxel-, sirolimus-, zotarolimus- and ridaforolimus-eluting coronary stents medically necessary for members with acute coronary syndrome, angina pectoris (stable ischemic heart disease) or silent ischemia who can tolerate anti-platelet or anti-coagulant therapy and who have one of these findings: coronary stenosis of 50% or greater in the left main coronary artery, angina that is refractory, contraindicated or intolerant to optimal medical therapy with 70% or greater stenosis in one or more coronary arteries, or angina that is refractory, contraindicated or intolerant to optimal medical therapy with coronary stenosis greater than 50% and fractional flow reserve (FFR) of 0.80 or less. FDA-approved drug-eluting stents are also covered for intra-coronary stent re-stenosis and for coronary lesions in Kawasaki disease. For peripheral arteries, the Eluvia system is covered for primary treatment of superficial femoral artery and proximal popliteal artery disease, and the Zilver PTX stent is covered for primary treatment of femoro-popliteal artery disease. Antibody-coated coronary stents, biodegradable polymer drug-eluting stents, drug-eluting ureteral stents for kidney stones, and drug-eluting stents for all other listed indications, including coronary artery aneurysms, vein graft stenosis, intracranial atherosclerotic stenosis, myocardial bridging and the Eluvia system for iliac artery stenosis, are considered experimental, investigational or unproven because their effectiveness has not been established.
Aetna · Identified Aug 19, 2026Medium impact
Intravascular Ultrasound (CPB 0382, reviewed 2026-05-26)
Aetna's clinical policy bulletin 0382 treats intravascular ultrasound (IVUS) as medically necessary when a symptomatic member's angiogram shows 50 to 70% stenosis before an intracoronary procedure, when suspected left main coronary disease is not shown by angiography, for guidance of vena caval filter placement, for guiding and immediately assessing coronary or graft interventions, for evaluating cardiac allograft vasculopathy after heart transplant, for diagnosing and following treatment of iliac vein compression (May-Thurner) syndrome, for type B aortic dissection treated with thoracic endovascular aneurysm repair when CT is poor quality or inconclusive, and for infra-inguinal arterial disease when CO2 angiography is used because standard contrast angiography is not possible. IVUS is considered experimental, investigational, or unproven for coronary artery disease screening, for virtual histology plaque evaluation, and for other indications including carotid artery stenosis evaluation, guidance of percutaneous mechanical thrombectomy for pulmonary embolism, chronic venous obstruction stenting, and stenting of non-coronary arteries.
Aetna · Identified Aug 18, 2026Medium impact
Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)
Aetna considers intravascular optical coherence tomography (OCT) medically necessary for procedural guidance to reduce ischemic events in members with acute coronary syndrome (ACS) undergoing coronary stent implantation in the left main artery or in complex lesions. Aetna considers intravascular OCT experimental, investigational, or unproven for all other indications, including carotid artery stenosis/stroke risk, intracranial aneurysm diagnosis and rupture assessment, pulmonary artery thrombus, cardiac allograft vasculopathy, follow-up evaluation of post-stent placement, guidance of percutaneous treatment of coronary bifurcation disease, and follow-up evaluation of renal arteries after radiofrequency catheter-based renal denervation. This policy was last reviewed 04/27/2026.
Aetna · Identified Aug 14, 2026Medium impact
Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)
Aetna's Clinical Policy Bulletin 0400 considers styloidectomy medically necessary for Eagle's syndrome only when specific criteria are met, with separate criteria for the non-vascular form and the vascular form linked to carotid artery dissection. Radiofrequency thermoneurolysis is considered experimental, investigational or unproven for Eagle's and Ernest syndromes, and styloidectomy for jugular vein stenosis, for carotid stenosis without dissection, and for other listed indications such as tinnitus, headache and neck pain is also considered experimental, investigational or unproven.
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.

Watch I65.21

Get one email when a payer policy names I65.21, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code I65.21?

There are 7 tracked policy changes affecting code I65.21, including updates from Excellus BlueCross BlueShield, 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 code I65.21?

Payers that have issued tracked updates for code I65.21 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code I65.21 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code I65.21. 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 code I65.21?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110

Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures (CPB 0276, reviewed 2026-09-10)

Drug-Eluting Stents (CPB 0621, reviewed 2026-09-23)

Intravascular Ultrasound (CPB 0382, reviewed 2026-05-26)

Intravascular Optical Coherence Tomography (CPB 0829, reviewed 2026-04-27)

Eagle's and Ernest Syndrome (CPB 0400, reviewed 2026-06-30)

Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

What insurance policy changes affect code I65.21?

Which payers have updated policy for code I65.21?

How do I get notified when code I65.21 policy changes?

Why do payers change policies for code I65.21?