Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency

Venous angioplasty, with or without stent placement, for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis is considered investigational and is not covered by Medicare due to inconclusive evidence that CCSVI impacts MS. CCSVI diagnosis in MS is typically based on extracranial/transcranial Doppler hemodynamic studies documenting stenotic or occlusive lesions, but endovascular correction has not been shown to be clinically effective. Stent placement after angioplasty is described in practice (with anticoagulation commonly used for at least three months), but this does not overcome the policy's determination of noncoverage.

"Venous angioplasty, with or without stent placement, of any internal jugular, azygos, or other thoracic veins for the treatment of multiple sclerosis is investigational and not medically necessary ..."