ICD-10 I74.3 is officially defined as "Embolism and thrombosis of arteries of the lower extremities." code I74.3 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I74.3 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
UnitedHealthcare's Medicare Advantage ambulatory electrocardiographic (AECG) monitoring policy was revised effective September 1, 2026, which has already passed. It adds a long list of ICD-10 diagnosis codes for the AECG CPT codes, revises coverage where no CMS local coverage determination exists, and says AECG monitoring with an FDA-cleared device is reasonable and necessary for arrhythmia monitoring before and after TAVR.
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.
Aetna considers electrical stimulation medically necessary durable medical equipment for arterial ulcers, diabetic ulcers, Stage III or IV pressure ulcers, and venous stasis ulcers when it is used as adjunctive therapy after no measurable signs of healing for at least 30 days of conventional wound treatment. Courses exceeding 1 hour per day are not considered medically necessary, continued stimulation is not medically necessary if measurable healing is not shown within a 4-week treatment period or once the wound bed is 100% epithelialized, and electrical stimulation for chronic ulcers in the home setting is considered not medically appropriate. Aetna considers electrical stimulation experimental, investigational, or unproven for uses including prevention of ulcers and pressure sores, infected wounds, microcurrent as an adjunctive therapy, and the VeinoPlus device for venous ulcers.
Aetna considers the AngioJet Rheolytic Thrombectomy System medically necessary for removing fresh blood clots from arterio-venous fistulas used for hemodialysis, from coronary arteries or coronary bypass grafts that are at least 2.0 mm in diameter before angioplasty or stent placement, and from infra-inguinal peripheral arteries at least 2.0 mm in diameter. It also considers the system medically necessary for individuals with lower extremity deep vein thrombosis who have failed pharmacologic thrombolysis or in whom pharmacologic thrombolysis is contraindicated. Aetna considers the AngioJet system experimental, investigational or unproven for acute aortic occlusion, acute renal artery thrombosis, cerebral venous sinus thrombosis, inferior vena cava filter-related thrombosis, May-Thurner syndrome-related deep venous thrombosis, pulmonary embolism, and thrombosis of the native aortic valve and of the left ventricular assist device in individuals with heart failure. Aetna also considers the ClotHunter system for lower extremity deep vein thrombosis, and mechanical thrombectomy and/or thrombo-aspiration for acute ilio-femoral deep vein thrombosis, experimental, investigational or unproven.
Aetna considers the Clarifi Imaging System, concurrent optical and magnetic stimulation (COMS) therapy for chronic leg and foot ulcers, the DeepView Wound Imaging System for burn assessment and wound healing prediction, the MolecuLight hand-held device for point-of-care fluorescence imaging of wounds, noncontact nonthermal low-frequency ultrasound therapy for wounds and all other indications, and Warm-Up Active Wound Therapy (noncontact normothermic wound therapy) experimental, investigational, or unproven. Several CPT, HCPCS, and ICD-10 codes are listed as not covered for the indications in the bulletin.
Aetna considers the AngioJet Rheolytic Thrombectomy System medically necessary for removing fresh blood clots from arteriovenous fistulas used for hemodialysis, from coronary arteries or coronary bypass grafts at least 2.0 mm in diameter before angioplasty or stent placement, from infra-inguinal peripheral arteries at least 2.0 mm in diameter, and in individuals with lower extremity deep vein thrombosis who have failed pharmacologic thrombolysis or in whom pharmacologic thrombolysis is contraindicated. Thrombectomy systems are considered experimental, investigational or unproven for acute aortic occlusion, acute renal artery thrombosis, cerebral venous sinus thrombosis, inferior vena cava filter-related thrombosis, May-Thurner syndrome-related deep venous thrombosis, pulmonary embolism, and thrombosis of the native aortic valve and of the left ventricular assist device in heart failure. The ClotHunter for lower extremity deep vein thrombosis and mechanical thrombectomy or thrombo-aspiration for acute ilio-femoral deep vein thrombosis are also considered experimental, investigational or unproven.
Aetna considers cardiac MRI medically necessary for a defined list of cardiovascular indications, including thoracic aortic disease, pericardial disease, congenital heart disease, atrial fibrillation, coronary artery disease, cardiomyopathies, myocarditis and cardiac masses, and several of these require that an echocardiogram was inconclusive or expected to be non-diagnostic. Requests for indications not listed are subject to medical review, and when CT, radionuclide studies, ultrasound or other MRI are also performed, the physician must document the specific information the additional test is expected to provide. Aetna considers absolute quantification of myocardial blood flow, four-dimensional flow cardiac MRI, whole heart coronary MR angiography, ferumoxytol-enhanced cardiac MRI, and cardiac MRI used as a screening test to be experimental, investigational or unproven.
Aetna considers electrical stimulation for chronic ulcers medically necessary durable medical equipment for arterial ulcers, diabetic ulcers, Stage III or IV pressure ulcers, and venous stasis ulcers when it is used as adjunctive therapy after there are no measurable signs of healing for at least 30 days of conventional wound treatment. A course of treatment is not typically expected to exceed 60 minutes per day or a total of more than 4 weeks, and continued stimulation is not medically necessary if measurable signs of healing are not demonstrated within a 4-week treatment period. Electrical stimulation for chronic ulcers in the home setting is considered not medically appropriate, and it is considered experimental, investigational, or unproven for uses such as prevention of ulcers and pressure sores, treatment of infected wounds, and microcurrent as an adjunctive therapy to enhance chronic wound healing.
Under this Aetna policy, covered arterial stenting with FDA-approved stents includes primary or salvage therapy for popliteal artery aneurysm when the aneurysm is symptomatic or 2.0 cm or larger and the member has high peri-operative surgical risk, primary therapy for common iliac, external iliac and chronic mesenteric ischemia, salvage therapy for femoral, popliteal and tibial arteries after a sub-optimal balloon result, and renal artery stenting for atherosclerotic disease when listed criteria are met. Covered venous stenting includes the superior vena cava for superior vena cava syndrome, post radiation venous stenosis or congenital stenosis, ilio-caval venous occlusion, hemodialysis access graft or fistula stenosis or occlusion, May-Thurner syndrome and recurrent cephalic arch stenosis. Biodegradable stents, hybrid foot vein arterialization, primary stenting of tibial or infra-popliteal lesions, the DETOUR system for peripheral arterial disease and the LimFlow Stent Graft System for critical limb ischemia are listed as experimental, investigational or unproven, and certain peripheral arterial disease procedures are reviewed by EviCore by Evernorth under its own medical necessity criteria.
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.
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