Peripheral Vascular Intervention Guidelines

Covers a wide range of peripheral vascular interventions as medically necessary when guideline indications are met — including carotid/vertebral revascularization (CEA/CAS/TCAR when appropriate), thoracic/abdominal aortic repair (TEVAR/EVAR), endoleak management, visceral/popliteal aneurysm repair, peripheral arterial/renal/mesenteric procedures, venous procedures (endovenous ablation, phlebectomy, sclerotherapy, stenting/angioplasty where indicated), IVUS use, and embolization — and explicitly excludes or labels investigational items such as routine intravascular lithotripsy, many below‑knee stents, Type 4 endoleak repair, high‑ligation without stripping, prophylactic NIVL stenting, genicular/hemorrhoid embolization, and other non‑covered scenarios. Coverage requires meeting specified numeric and clinical thresholds (aneurysm diameters, stenosis percentages, ABI/TBI/duplex PSV criteria), documented failure of conservative therapy when required, timely confirmatory imaging and clinical documentation (generally within 6 months), adherence to FDA‑approved device indications, and specific emergent exceptions and limitations per the guideline.