Peripheral Atherectomy and Thrombectomy Devices (CPB 0295, reviewed 2026-04-16)
Summary
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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