Percutaneous transluminal angioplasty, with or without stenting, may be considered medically necessary for listed venous stenoses, including stenotic lesions of arteriovenous dialysis fistulas and grafts, superior or inferior vena cava syndrome with significant symptoms, left iliac vein compression syndrome (May-Thurner Syndrome), and venous thoracic outlet syndrome (Paget-Schroetter syndrome) with persistent extrinsic compression. Venous angioplasty and stenting is considered investigational when the policy criteria are not met and for other venous indications, including deep vein thrombosis not related to the listed indications, chronic cerebrospinal venous insufficiency in multiple sclerosis, and venous sinus obstruction or occlusion in idiopathic intracranial hypertension.
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01Billing team and providers: submit the History and Physical or chart notes and documentation of symptoms, associated diagnoses and treatments for review, because these items are needed to determine whether the policy criteria are met.
02For venous thoracic outlet syndrome (Paget-Schroetter syndrome), document persistent extrinsic compression with pre-procedure imaging (ultrasound, venography, CT, or MRI).
03If these items are not submitted, it could impact the review and decision outcome.
04Providers may bill members for services considered investigational and are encouraged to inform members before rendering such services that the members are likely to be financially responsible for the cost.
Codes mentioned
3648137238372393724837249C2623
Original notice
Percutaneous Angioplasty and Stenting of Veins
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