Medicare AdvantageCoverageMedium impact
MA11.056h, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Independence Blue Cross·Neurosurgery, Vascular Surgery, Radiology·Medical Policy
Effective date
Apr 2, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued policy (MA11.056h) effective April 2, 2025 governing coverage and billing for Percutaneous Transluminal Angioplasty (PTA) with or without stenting performed concurrently with Extracranial-Intracranial (EC-IC) arterial bypass surgery. The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and applicable billing codes for these neurovascular procedures under Medicare Advantage plans.
Action Required
By April 2, 2025: Billing team must obtain and review the complete MA11.056h policy document from the source URL to identify: (1) specific CPT codes for PTA and stenting procedures, (2) prior authorization requirements and submission procedures, (3) documentation requirements for EC-IC bypass cases, and (4) any bundling or modifier rules. Update billing software, encounter forms, and provider alerts accordingly. Communicate policy details to neurosurgery and interventional radiology providers. Do not bill for these procedures without confirming coverage criteria are met. Failure to follow updated policy will result in claim denials on Medicare Advantage plans.