Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

Endovascular management for peripheral arterial disease is covered when patients have symptomatic disease with objective evidence (e.g., ABI ≤0.9 for LE) and have failed adequate guideline-directed medical therapy and structured exercise, or when revascularization is needed to preserve limb viability, hemodialysis access, or to enable other procedures (e.g., CABG). CLTI and salvageable acute limb ischemia are indications for revascularization; asymptomatic disease is generally not covered except for specific procedural or access-related reasons. Documentation requirements include ABI/WBI, appropriate vascular imaging to define anatomy, evidence of prior GDMT/SET (≥90 days or GDMT within 3 months), provider training/licensure, and appropriate accredited site-of-service.

"Endovascular revascularization of symptomatic upper extremity (UE) arterial disease is covered for threatened UE perfusion, coronary-subclavian steal syndrome with significant cardiac symptoms, emb..."