CommercialAdministrativeLow impact
11.02.10p, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Independence Blue Cross·Vascular Surgery, Cardiothoracic Surgery, General Surgery·Medical Policy
We identified it
Jun 19, 2026
Summary
This is a reissue with no substantive changes to policy 11.02.10p regarding endovascular grafts for abdominal aortic aneurysms (AAA), aorto-iliac aneurysms, and infrarenal aortic aneurysms. The policy maintains its current coverage position for FDA-approved devices and continues to classify all other uses as experimental/investigational. Two CPT codes (33894, 33895) were added to the policy during a 2022 code update, but no material policy changes have occurred since the original 01/01/2022 effective date.
Action Required
No immediate action required. This is a routine annual reissue with no substantive changes to coverage criteria, billing codes, or documentation requirements. Billing team should verify that CPT codes 33894 and 33895 remain in the billing system if not already present. Continue applying existing medical necessity criteria for AAA endovascular graft procedures and ensure claims include appropriate ICD-10 diagnosis codes supporting medical necessity per the policy.