Dialysis Access Maintenance

Medically necessary percutaneous and open procedures to restore or maintain patency of AV dialysis accesses (fistulas and grafts) are covered for symptomatic or objectively documented dysfunction (e.g., threatened occlusion, recent thrombosis, pseudoaneurysm, venous pressure abnormalities, recirculation >10–15%, or stenosis ≥50%). Diagnostic fistulagram and non-invasive vascular studies are covered when clinical signs/symptoms indicate impending failure and results will affect management; routine surveillance testing without symptoms is not covered. Stents and non–FDA-approved devices are restricted: stents may be covered as last-resort salvage (with FDA approval or acceptable IDE documentation) in specific scenarios, and interventions for graft thrombus older than one year are not covered.

"Percutaneous or open interventions to restore or maintain functional patency of an arteriovenous (AV) dialysis access (AV fistula or AV graft) for compromised flow, threatened occlusion, recent thr..."