Extracranial Carotid Angioplasty or Stenting

This policy covers extracranial carotid angioplasty with stenting (including TCAR and transcarotid systems such as ENROUTE) as a treatment or less‑invasive alternative to carotid endarterectomy for patients with carotid artery stenosis—primarily symptomatic patients meeting NASCET thresholds (generally ≥50% by angiogram or ≥70% by duplex) and selected asymptomatic patients with device‑specific higher stenosis criteria, and for those with anatomic contraindications to CEA or who are high surgical risk. Coverage requires use of FDA‑approved carotid stents with embolic protection devices, stenosis assessment per ultrasound or angiography per NASCET, compliance with device labeling and anatomic requirements (e.g., ENROUTE bifurcation ≥5 cm above the clavicle), and excludes routine use in patients who are suitable candidates for CEA or any off‑label/experimental indications.

"Carotid angioplasty with associated stenting and embolic protection or TCAR for patients with 50%–99% carotid stenosis (NASCET measurement) who have symptoms of focal cerebral ischemia (TIA or mono..."