37182
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
16.55
Facility
$701.08
Non-Facility
$701.08
Documentation Required
- Claims must be submitted with an ICD-10-CM code that represents the reason for the procedure, billed to the highest level of specificity and linked to the appropriate procedure code.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
- The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
- Medical record documentation should list the type and length of conservative treatment attempted, as applicable per LCD L37893.
Key Coverage Criteria
- Endovenous stenting is covered when performed to treat severely symptomatic venous obstructions in accordance with LCD L37893.
- Endovenous stenting is covered when used to treat severely symptomatic venous obstructions in accordance with LCD L38231.
- Placement of an endovenous stent as an adjunct to a suboptimal or failed percutaneous transluminal angioplasty (PTA) when residual stenosis is >30% measured at the narrowest point of the lumen or when there is >50% reduction of luminal diameter.
- Placement of an endovenous stent for angioplasty-related complications including an intimal tear with hemorrhage, abrupt persistent occlusion, dissection at the angioplasty site, occlusion from elastic recoil, or refractory spasm.
- Primary endovenous stenting when angioplasty alone is not expected to provide a durable result (i.e., planned primary stent placement rather than post-angioplasty rescue).
- Endovenous stenting for iliac vein compression syndrome (May-Thurner/Cockett syndrome) causing severe symptoms or obstruction.
7 Active Policies
L38231 — Endovenous Stenting
J09
A56644 — Billing and Coding: Endovenous Stenting
J09
L37893 — Endovenous Stenting
J12
A56414 — Billing and Coding: Endovenous Stenting
J12
FIRST_COAST-L38231 — Endovenous Stenting
Related Codes
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