Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions

Coronary artery brachytherapy is covered only as an adjunct during a repeat angioplasty/stent for localized in‑stent restenosis within a previously placed bare‑metal stent, and abciximab is covered as an adjunct for percutaneous angioplasty/stent placement; brachytherapy with drug‑eluting stents, primary prevention or other non‑listed indications, abciximab for multiple investigational indications (including AMI without PCI), and intravascular shockwave lithotripsy are excluded/experimental. Coverage requires documentation that the policy’s selection criteria are met (i.e., documented in‑stent restenosis during a second procedure) and use of the specified CPT/HCPCS/ICD‑10 codes for billing.

"Abciximab for patients with unstable angina not responding to conventional medical therapy when percutaneous coronary intervention is planned within 24 hours (FDA‑labeled indication)."