Balloon-expandable venous stent placement, with or without initial thrombolysis or surgical thrombectomy, is medically necessary for Budd-Chiari syndrome, chronic iliac vein or ilio-caval occlusion, ilio-femoral venous obstructive disease, superior or inferior vena caval stenosis, symptomatic pelvic venous spurs (May-Thurner syndrome), and salvage of thrombosed or stenotic arterio-venous dialysis access grafts. Stenting for superior vena cava occlusive disease is also medically necessary. Stenting for all other indications is experimental, investigational, or unproven, including central vein stenosis in hemodialysis individuals and porto-mesenteric and porto-systemic venous reconstruction.
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01Billing team: Bill CPT 37238 and 37239 for balloon-expandable venous stent placement only when the member has one of the medically necessary indications in the policy.
02Billing team: Do not bill CPT 37248 or 37249 as covered for porto-mesenteric or porto-systemic venous reconstruction, which the policy lists as not covered.
03Billing team: Do not bill these services as covered for central vein stenosis in hemodialysis individuals, which the policy lists as not covered under ICD-10 code Z99.2.
Summaries are AI-assisted. Always confirm against the original payer notice.
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