Aetna considers placement of balloon-expandable venous stents, with or without initial thrombolysis or surgical thrombectomy, medically necessary for Budd-Chiari syndrome, chronic iliac vein occlusions, chronic ilio-caval vein obstruction, ilio-femoral thrombosis secondary to iliac compression syndrome, ilio-femoral venous obstructive disease, post-operative venous narrowing after repair of sinus venosus atrial septal defect, salvage of thrombosed or stenotic arterio-venous dialysis access grafts, superior or inferior vena caval stenosis in a child or adult, symptomatic pelvic venous spurs (May-Thurner syndrome), and venous obstruction of the superior or inferior limb of an atrial baffle after Mustard or Senning repair. Venous stenting is also medically necessary for superior vena cava occlusive disease. Balloon-expandable venous stents are experimental, investigational, or unproven for all other indications, including management of central vein stenosis in hemodialysis individuals and porto-mesenteric and porto-systemic venous reconstruction.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
01Billing team: For the listed indications, CPT 37238 (initial vein) and 37239 (each additional vein) are covered when the selection criteria are met, and CPT 37248 and 37249 cover balloon angioplasty within the same vein.
02Code each claim with the ICD-10 code that matches the indication, such as I82.0 for Budd-Chiari syndrome or I82.521 through I82.529 for chronic iliac vein occlusions.
03Do not bill these services for central vein stenosis in hemodialysis individuals, because Z99.2 and T82.858A through T82.858S are not covered for that indication.
04Do not bill CPT 37248 or 37249 for porto-mesenteric and porto-systemic venous reconstruction, because the source states those codes are not covered for that use.
05Balloon-expandable venous stents for any other indication are experimental, investigational, or unproven and are not covered.
Summaries are AI-assisted. Always confirm against the original payer notice.
What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.