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Excellus BlueCross BlueShieldCommercial · Coverage · Nervous Systems (Neurology) · NY · Neurology, Cardiology, Vascular Surgery +1 moreMedium impact

Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110

Effective date
Dec 18, 2025
Identified
Jun 20, 2026

Summary

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.

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What to do

Action · 5 steps
01Already effective December 18, 2025: For carotid angioplasty with or without stenting by transfemoral or TCAR, billing team should document that the patient is symptomatic with greater than 50% carotid artery stenosis, or asymptomatic with greater than 70% stenosis of the common or internal artery, and that the patient is at risk for adverse outcomes during carotid endarterectomy.
02Document the high-risk basis that the surgeon has determined, such as NYHA Class III or IV congestive heart failure, left ventricular ejection fraction less than 30 percent, unstable angina, contralateral carotid artery occlusion, recent myocardial infarction, previous CEA with recurrent stenosis, or an anatomic contraindication to CEA.
03The policy lists contraindications to carotid stenting that include contraindication to anticoagulant or antiplatelet therapy, known nickel-titanium hypersensitivity, uncorrected bleeding disorders, and lesions in the ostium of the common carotid artery.
04Vertebral artery stenting (CPT 0075T and 0076T) and intracranial angioplasty and stenting (CPT 61630 and 61635) are investigational under this policy and are marked (E/I).
05Codes may not be covered under all circumstances, and services are contract dependent, so check the member's subscriber contract before billing.

Codes mentioned

36221362233622436228372153721637217372186163061635G45.0G45.2G45.8G45.9I63.011I63.019I63.111I63.119I63.211I63.219I63.031I63.039I63.131I63.139I63.231I63.239I63.59I65.01I65.09I65.21I65.8I65.9I66.01I66.9

Original notice

Angioplasty and Stenting of Extracranial, Intracranial and Vertebral Arteries 7.01.110
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesNeurologyCardiologyVascular SurgeryRadiologyCode 36221Code 36223Code 36224Code 36228Code 37215Code 37216Code 37217Code 37218Code 61630Code 61635Code G45.0Code G45.2Code G45.8Code G45.9Code I63.011Code I63.019Code I63.111Code I63.119Code I63.211Code I63.219Code I63.031Code I63.039Code I63.131Code I63.139Code I63.231Code I63.239Code I63.59Code I65.01Code I65.09Code I65.21Code I65.8Code I65.9Code I66.01Code I66.9

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