Payer PolicyActive
AngioJet Rheolytic Thrombectomy System
AETNA-CPB-0568
Aetna
Effective: August 10, 2023
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Aetna covers the AngioJet Rheolytic Thrombectomy System for removal of fresh blood clots in arteriovenous hemodialysis fistulas/grafts, coronary arteries or bypass grafts ≥2.0 mm (prior to angioplasty or stent placement), and infra‑inguinal peripheral arteries ≥2.0 mm. It considers the device experimental/investigational (not covered) for indications such as acute aortic occlusion, acute renal artery thrombosis, cerebral venous sinus thrombosis, and May‑Thurner–related DVT because effectiveness has not been established.
Coverage Criteria Preview
Key requirements from the full policy
"(Inferred) For coronary or peripheral arterial use: documentation of vessel diameter ≥2."
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