Drug-Eluting Stents
AETNA-CPB-0621
FDA‑approved drug‑eluting stents (everolimus, paclitaxel, sirolimus, zotarolimus, ridaforolimus) are covered for acute coronary syndrome, stable ischemic heart disease (angina) or silent ischemia in patients who can tolerate antiplatelet/anticoagulant therapy when there is ≥50% left main stenosis, for angina refractory/contraindicated/intolerant to optimal medical therapy with ≥70% stenosis (or ≥50% stenosis with FFR ≤0.80), and for intra‑coronary stent restenosis and Kawasaki disease. All other uses are considered experimental/investigational (not covered), including but not limited to Takayasu arteritis, AV graft outflow vein stenosis in hemodialysis, chronic kidney disease with multivessel disease, coronary aneurysms, and esophageal strictures.
"No explicit limitations, exclusions, frequency limits, or patient-eligibility criteria are stated in the provided text (bibliography only)."