Medicare AdvantagePrior AuthHigh impact
MA11.113k, Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound
Independence Blue Cross·Cardiology, Cardiothoracic Surgery, Vascular Surgery +1 more·Medical Policy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Policy MA11.113k updates medical necessity criteria for Percutaneous Coronary Intervention (PCI), Coronary Angiography, and Arterial Ultrasound effective March 24, 2025. This recent policy change establishes new requirements for Medicare Advantage plans and may affect prior authorization workflows, documentation requirements, and claim adjudication for cardiac interventional procedures.
Action Required
By March 24, 2025: Billing team and cardiology providers must review the full policy text at the source URL to identify specific medical necessity criteria updates for PCI, Coronary Angiography, and Arterial Ultrasound procedures. Update prior authorization templates, billing system rules, and provider documentation requirements in the EMR to align with new criteria. Determine which CPT codes (likely 92920, 92921, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944, 93000-93010 range for angiography/ultrasound) require modified prior auth submissions. Communicate changes to all cardiology and interventional radiology staff. Claims submitted without compliance to new medical necessity criteria will face denials. Contact the plan using the policy URL for clarification on specific code-level requirements if not detailed in full policy text.