CG-SURG-106 Venous Angioplasty with or without Stent Placement or Venous Stenting Alone

This policy addresses venous angioplasty with or without stent placement, or venous stenting alone, to open obstructed veins. It is considered medically necessary only for venous thoracic outlet syndrome, thrombotic obstruction of major hepatic veins (Budd-Chiari syndrome), superior vena cava syndrome, or iliac vein compression syndrome (e.g., May-Thurner). It is not medically necessary for all other indications, including multiple sclerosis, chronically occluded iliac veins, iliofemoral venous thrombosis, and nutcracker syndrome.

"Venous angioplasty with or without stent placement or venous stenting alone is consideredmedically necessaryfor treatment of the following conditions:"

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