Does 37226 require prior authorization?

No, 37226 does not require prior authorization (high confidence). Code is covered without prior authorization.

`37226`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Billing and coding guidance for non-coronary vascular stents is dependent on the coverage indications, limitations, and medical necessity specified in the related Local Coverage Determination (LCD); consult the related LCD for the specific coverage and coding requirements.
Document the clinical decision-making process for choosing endovascular versus open or hybrid revascularization, oriented to patient-centered goals.
Document the availability of autologous vein conduit, preferably a >3 mm single-segment great saphenous vein, when relevant to revascularization planning.
Document coronary artery disease status (symptomatic or asymptomatic).

Endovascular revascularization is appropriate when the individualized, patient-centered clinical decision favors endovascular over open or hybrid revascularization for peripheral arterial disease of the upper or lower extremities.
Anatomically less-complex lesions in patients with claudication or chronic limb-threatening ischemia (CLTI) are typically treated with an endovascular approach.
Stent placement is covered to enhance primary patency of stenotic or occlusive arteries or veins, including as an adjunct to PTA when PTA alone is technically inadequate or not expected to provide a durable result.
Coverage allowed when the patient has undergone prior thorough medical evaluation and management of symptoms documented in the record.
Stenting is covered when surgical intervention would otherwise be considered the alternative treatment for the patient.
Primary (planned) stent deployment is covered when PTA alone is not expected to be durable, e.g., lesions with high risk of distal embolization, rapid recurrence, significant concentric calcification, eccentric lesions, lesions due to external compression (May-Thurner, malignant SVC compression), or ostial renal artery stenosis.

A57590 — Billing and Coding: Non-Coronary Vascular Stents

J05

L35998 — Non-Coronary Vascular Stents

J05

A60246 — Billing and Coding: Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

L40227 — Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

Ask Verity about documentation requirements, denial risks, or coverage in your state.