LCDActive
Computed Tomography Cerebral Perfusion Analysis (CTP)
L38667
National Government Services, Inc. (J06)
Effective: November 1, 2020
Updated: December 31, 2025
Policy Summary
CTP with automated post-processing is covered for patients with small acute ischemic stroke due to a unilateral large vessel occlusion in the proximal anterior circulation evaluated at stroke centers. CTP may be used to aid selection for endovascular mechanical thrombectomy when femoral puncture can be initiated within 6–24 hours (per DAWN) or 6–16 hours (per DEFUSE 3) of last known well and when the patient meets the respective trial pre-CTP inclusion/exclusion criteria (excluding criteria related only to study mechanics).
Coverage Criteria Preview
Key requirements from the full policy
"CTP using automated post-processing software algorithmic analysis is medically reasonable and necessary for patients with small acute ischemic stroke caused by a unilateral large vessel occlusion i..."
Sign up to see full coverage criteria, indications, and limitations.