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Revised Claims and Payment Policy: Leg Stent Coding Updates

Effective October 1, 2023, Ambetter, Meridian Medicaid Plan, Meridian Medicare-Medicaid Plan (MMP), YouthCare, and Wellcare of Illinois (Wellcare) are reinforcing the prior auth review for leg stent coding.

Summary of Policy

We are reminding providers the following vascular codes require a medical necessity review, therefore please submit complete supporting clinical records, including clinical notes, for prior authorization requests for the codes noted below.

 

CPT Description

CTP Code

ILIAC REVASC

37220

ILIAC REVASC W/STENT

37221

FEM/POPL REVAS W/TLA

37224

FEM/POPL REVAS W/ATHER

37225

FEM/POPL REVASC W/STENT

37226

FEM/POPL REVASC STNT & ATHER

37227

TIB/PER REVASC W/TLA

37228

TIB/PER REVASC W/ATHER

37229

TIB/PER REVASC W/STENT

37230

TIB/PER REVASC STENT & ATHER

37231

 

Please review the Endovascular Intervention Peripheral Artery.

We are here to help. Please contact your Provider Relations representative for general inquiries.

For Meridian Provider Services call 866-606-3700, Monday through Friday, from 8 a.m. to 5 p.m.
For Meridian MMP Provider Services call 855-580-1689, Monday through Friday, from 8 a.m. to 5 p.m.
For Wellcare Provider Services call 855-538-0454, Monday through Sunday, from 8 a.m. to 8 p.m.
For YouthCare Provider Services call 844-289-2264, Monday through Friday, from 8 a.m. to 6 p.m.

 

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Last Updated On: 10/24/2023
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