Peripheral Interventions Coverage
CMS Coverage of Percutaneous Transluminal Angioplasty (PTA)
The information below is excerpted from Medicare’s National Coverage Policy for PTA.
This procedure involves inserting a balloon catheter into a narrow or occluded blood vessel to recanalize and dilate the vessel by inflating the balloon. The objective of PTA is to improve the blood flow through the diseased segment of a vessel so that vessel patency is increased and embolization is decreased. With the development and use of balloon angioplasty for treatment of atherosclerotic and other vascular stenoses, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of peripheral, renal, and coronary arteries.
Nationally Covered Indications
Nationally Noncovered Indications
Nationally Covered Indications
The PTA is covered to treat the following indications:
Atherosclerotic obstructive lesions:
In the lower extremities, i.e., the iliac, femoral, and popliteal arteries, or in the upper extremities, i.e., the innominate, subclavian, axillary, and brachial arteries. The upper extremities do not include head or neck vessels.
Of the renal arteries for patients in whom there is an inadequate response to a thorough medical management of symptoms and for whom surgery is the likely alternative. The PTA for this group of patients is an alternative to surgery, not simply an addition to medical management.
Of arteriovenous dialysis fistulas and grafts when performed through either a venous or arterial approach.
Nationally Noncovered Indications
Performance of PTA to treat obstructive lesions of the vertebral and cerebral arteries remains noncovered. The safety and efficacy of these procedures are not established.
All other indications for PTA for which CMS has not specifically indicated coverage remain non-covered.
The information below is excerpted from Medicare’s National Coverage Policy for PTA.
This procedure involves inserting a balloon catheter into a narrow or occluded blood vessel to recanalize and dilate the vessel by inflating the balloon. The objective of PTA is to improve the blood flow through the diseased segment of a vessel so that vessel patency is increased and embolization is decreased. With the development and use of balloon angioplasty for treatment of atherosclerotic and other vascular stenoses, PTA (with and without the placement of a stent) is a widely used technique for dilating lesions of peripheral, renal, and coronary arteries.
Medicare Coverage
CMS coverage of PTA with stenting
Medicare coverage of peripheral vessel stenting falls under local Medicare coverage. This means that each local Medicare office has determined their coverage policy for the stenting of peripheral vessels, which may follow PTA. Coverage for peripheral vessel stenting may vary by Medicare contractor. Therefore, for reimbursement purposes, Abbott vascular recommends that providers verify Medicare coverage of peripheral procedures prior to date of service.
Commercial Coverage
Commercial Coverage of PTA may vary.
For reimbursement purposes, Abbott Vascular recommends that providers verify insurance coverage prior to performing a procedure.
References:
Centers for Medicare and Medicaid Services at www.cms.hhs.gov
Centers for Medicare and Medicaid Services at: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/pdf/05-22136.pdf
ICD-9-CM for Hospitals – Volumes 1,2 & 3; 2006 Professional; 6th edition; edited by Anita C. Hart, RHIA, CCS, CCS-P, Catherine A. Hopkins, Beth Ford, RHIT, CCS; Ingenix
CPT® is a trademark of the American Medical Association.
Current Procedure Terminology (CPT®) is copyright 2005. American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
American Medical Association. Current Procedural Terminology (CPT®) 2005. Professional Edition. Chicago, IL: 2005.
LT2922560
