ICD-10 I74.4 is officially defined as "Embolism and thrombosis of arteries of extremities, unspecified." code I74.4 is referenced in 5 tracked payer policy changes from UnitedHealthcare and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code I74.4 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.
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 full-leg or half-leg home-use pneumatic compression devices medically necessary durable medical equipment for chronic venous insufficiency of the legs in members with venous stasis ulcers that have failed to heal after a 6-month trial of conservative therapy directed by the treating physician. Intermittent pneumatic compression devices for the lower extremities are considered medically necessary for members who are bedridden due to trauma, orthopedic surgery, neurosurgery or other circumstances preventing ambulation, and a single patient use device is considered not medically necessary. Aetna lists other uses as experimental, investigational or unproven, including treatment of critical limb ischemia, intermittent claudication, post-thrombotic syndrome, restless legs syndrome and intra-operative compression for reduction of venous thromboembolism in craniotomy.
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 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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