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Revised Claims & Payment Policy: Leg Stent Coding Updates

Wellcare is reinforcing the prior authorization review for Leg Stent Coding with an effective date as of May 2, 2022.

Summary of Policy:
Wellcare is reminding providers to provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which require a medical necessity review.

 
CPT Description CPT Code

ILIAC REVASC

ILIAC REVASC W/ STENT

FEM/POPL REVAS W/TLA

FEM/POPL REVAS W/ATHER

FEM/POPL REVASC W/STENT

FEM/POPL REVASC STNT & ATHER

TIB/PER REVASC W/TLA

TIB/PER REVASC W/ATHER

TIB/PER REVASC W/STENT

TIB/PER REVASC STENT & ATHER

37220

37221

37224

37225

37226

37227

37228

37229

37230

37231

What does this mean for providers?

Providers are currently required to submit all pertinent clinical records when submitting a prior authorization request for these 10 codes.

Providers can review posted payment policies at: Wellcare.com/Texas/Providers/Medicare/Claims/Payment-Policy.

We are here to help. Please contact your Network Representative for general inquiries regarding this program.

 

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Y0020_WCM_87476E Last Updated On: 1/10/2024