Payment can be made for carotid angioplasty with stenting (cervical, extracranial vertebral, or intrathoracic carotid artery)(37215, 37216, 0075T, 0076T) when performed on high-risk, symptomatic patients. This is further defined as carotid stenosis >50% in patients with any of the following indications:

• contralateral carotid occlusion
• contralateral laryngeal nerve palsy
• radiation therapy to neck
• radical neck surgery
• previous CEA with recurrent stenosis
• severe tandem lesions
• Class III or IV heart failure
• left ventricular ejection fraction <30%
• open heart surgery within six months
• myocardial infarction one to four weeks prior to stenting
• Class III or IV angina
• severe pulmonary disease
• lesions that extend too high to be accessible for endarterectomy, but can be stented
• not a surgical candidate (this must be clearly documented in the medical record)

Codes 37215, 37216, 0075T, and 0076T include all ipsilateral selective carotid catheterization, all diagnostic imaging for ipsilateral carotid arteriography, and all related radiological supervision and interpretation.

Carotid angioplasty with stenting for any other indications including asymptomatic patients is considered experimental/investigational and, therefore, is not covered. Long-term effects remain unknown. A participating, preferred, or network provider can bill the member for the denied procedure in this instance.

Description

Carotid angioplasty with stenting uses a catheter-based technique to treat carotid artery stenosis. Carotid artery stenosis is treated to prevent stroke.

This procedure is performed via percutaneous access to the arterial system, typically by route of the femoral artery. An embolic protection device, if used, is then advanced beyond the stenotic region. Its purpose is to catch and prevent any debris from traveling to the brain. Balloon angioplasty is then performed to dilate the lesion. This is followed by the placement of a stent. The embolic protection device is then removed.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

PRN References

08/2001, Carotid angioplasty/stenting considered investigational
12/2004, Carotid artery stenting coverage guidelines explained

Angioplasty and Stenting of the Extracranial Carotid Arteries, Texas Heart Institute Journal, Vol. 27, 2000

Safety and Efficacy of Elective Carotid Artery Stenting in High-Risk Patients, Journal of the American College of Cardiology, Vol. 35, 06/2000

Intermediate Outcome After Carotid Stenting: What Should We Expect, Seminars of Vascular Surgery, Vol. 13, 06/2000

Carotid Endarterectomy Versus Carotid Angioplasty: Comparisons of Current Results, Seminars in Vascular Surgery, Vol. 13, 06/2000

Comparison of Non-Neurological Events in High-Risk Patients Treated by Carotid Angioplasty vs. Endarterectomy, American Journal of Surgery, Vol. 185, No. 4, 04/2003

Angioplasty and Stenting for Stroke Prevention, Neurology, Vol. 59, 09/2002

Percutaneous Treatment for Carotid Stenosis, Cardiology Clinics, 11/2004

Carotid Artery Stent Placement - Ready for Prime Time?, Journal of Vascular Interventional Radiology, Vol 14, No. 1, 01/2003

Carotid Endarterectomy Remains the Gold Standard, The American Journal of Surgery, 2002

Carotid Artery Stenting: Current Status and Future Directions, Vascular and Endovascular Surgery, Vol. 37, No. 5, 2003

A Refined Angioplasty and Stenting Technique May Offer an Alternative to Carotid Endarterectomy, The Journal of Cardiovascular Nursing, Vol. 18, No. 5, 2003

Controversies in Carotid Stenting, Vascular and Endovascular Surgery, Vol. 37, No. 2, 2003

Early Results of Carotid Stent Placement for Treatment of Extracranial Carotid Bifurcation Occlusive Disease, Journal of Vascular Surgery, Vol. 39, Issue 6, 06/2004