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Revised Claims & Payment Policy: Leg Stent Coding Updates

WellCare is reinforcing the prior auth review for Leg Stent Coding with an effective date as of July 1, 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

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

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 the complete policy at: https://www.wellcare.com/Kentucky/Providers/Medicare/Claims/Payment-Policy

 

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Last Updated On: 5/25/2022