Does C9764 require prior authorization?

Yes, C9764 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`C9764`, Revascularization, endovascular, open or percutaneous, lower extremity

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Procedure codes are provided only as a general reference and may not be all-inclusive.
Presence or absence of procedure/service/supply/device codes in the policy does not determine benefit coverage or reimbursement; only the written coverage position should be used.
Coverage determinations based on the Medical Policy must include review of the member's benefit contract or SPD for coverage vs non-coverage, exclusions, and benefit limitations (e.g., dollar or duration caps).

Medically necessary for chronic symptomatic PAD when: functionally limiting claudication; inadequate response to GDMT including structured exercise; and expected quality-of-life/walking/functional benefit outweighs risks/durability of intervention.
Percutaneous revascularization for treatment of chronic limb-threatening ischemia may be considered medically necessary.
Percutaneous revascularization for treatment of acute limb ischemia may be considered medically necessary.
Percutaneous revascularization for chronic symptomatic lower extremity PAD may be medically necessary when: functionally limiting claudication; inadequate response to guideline-directed management and therapy (including structured exercise); and potential benefits outweigh risks, durability concerns, and possible need for repeat procedures.
Percutaneous revascularization in individuals with asymptomatic lower extremity PAD may be medically necessary when required for the safety, feasibility, or effectiveness of other invasive, clinically necessary, life-saving procedures (examples provided).
Percutaneous revascularization for chronic symptomatic lower extremity PAD may be medically necessary when: functionally limiting claudication; inadequate response to guideline-directed management and therapy (including structured exercise); and potential benefits outweigh risks, durability concerns, and possible need for repeat procedures.

PALMETTO-JJ-L40228, Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

PALMETTO-JM-L40228, Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

BCBSNM-SUR707.034, Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease

CARELON-endovascular-revascularization-2025-11-15-updated-2026-01-01, Endovascular Revascularization

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