Percutaneous Coronary Interventions

Percutaneous coronary intervention (PCI) is covered for acute coronary syndromes, significant obstructive coronary atherosclerosis, restenosis after prior revascularization, and for chronic angina or silent ischemia when clinically appropriate. Diagnostic cardiac catheterization is covered any time prior to PCI (including same day); intracoronary ultrasound (IVUS) and fractional flow reserve (FFR) may be covered when clinically indicated with written documentation. PCI is not generally covered for patients manageable with medical therapy or for stable CAD alone; right heart/Swan-Ganz catheterization and standby surgical/anesthesia services are not covered, and repeat diagnostic catheterization within 3 months is generally not reimbursable unless new clinical findings exist.

"Percutaneous coronary intervention (PCI) is indicated for acute coronary syndrome, including acute myocardial infarction and unstable angina."