Peripheral Artery Revascularization of the Lower Extremities - Medicare Advantage
HUMANA-PERIPHERAL-ARTERY-REVASCULARIZATION-OF-THE-LOWER-EXTREMITIES-MA
This Humana Medicare Advantage policy follows applicable CMS NCDs/LCDs and covers endovascular revascularization procedures (including PTA and stenting per NCD 20.7) for atherosclerotic obstructive lesions of the lower extremities and allows atherectomy in specified situations (CLTI Rutherford 4-6, documented ISR, threatened bypass graft). The policy explicitly does not consider aorto-iliac atherectomy, deep vein arterialization, intravascular lithotripsy for lower extremities, and percutaneous transmural arterial bypass medically reasonable and necessary, and requires objective diagnostic documentation (eg, ABI/TBI/TCPO2, Rutherford classification, failed GDMT) and adherence to applicable NCDs/LCDs.
"Percutaneous transluminal angioplasty (PTA) ."
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