All PlansCoverageMedium impact
Extracranial Carotid Angioplasty and Stenting and Embolic Protection Devices
Regence BlueShield·Cardiology, Vascular Surgery, Neurology +1 more·Coding
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
This policy establishes coverage criteria for extracranial carotid angioplasty and stenting procedures. Coverage requires specific stenosis percentages (80% or 50% with symptoms) AND anatomic contraindications for carotid endarterectomy. Bilateral embolic protection devices are considered investigational.
Action Required
Before April 1, 2026: Billing team must establish prior authorization workflow for carotid angioplasty and stenting procedures. Create documentation checklist requiring: stenosis percentage documentation, symptom history (if applicable), and anatomic contraindications for endarterectomy. Train providers on required documentation elements. Claims will be denied without proper medical necessity documentation.