Percutaneous Coronary Intervention - Medicare Advantage

This policy covers percutaneous coronary intervention (PCI) — including PTCA, stent placement, atherectomy, aspiration thrombectomy and adjunctive technologies such as intravascular lithotripsy — for evaluation and treatment of coronary artery disease and acute coronary syndromes (eg, angina, myocardial infarction/STEMI), including management of in‑stent restenosis. Coverage is subject to Medicare NCDs/LCDs and MAC jurisdictional LCAs, requires services be reasonable and necessary (eg, lifestyle‑limiting angina despite guideline‑directed medical therapy, >70% stenosis except left main or positive physiologic testing with FFR ≤0.80/iFR ≤0.89), generally requires ability to tolerate dual antiplatelet therapy, and limits some indications (eg, STEMI treatment typically within 45 days).

"Implied requirement: follow documentation requirements as specified in the applicable MAC LCD/LCA (users must refer to the referenced MAC LCD/LCA for any required clinical documentation)."