Medical_Policy

Highmark Commercial Medical Policy - Pennsylvania

Medical Policy:	S-20-010
Topic:	Arterial Puncture Hemostasis (e.g., Angio-Seal)
Section:	Surgery
Effective Date:	October 14, 2013
Issue Date:	July 2, 2018
Last Reviewed:	June 2018

Diagnostic angiography and interventional catheterization procedures (e.g., heart catheterization) require femoral arterial puncture closure immediately after the catheter has been removed. The most common method to stop the bleeding (hemostasis) at the puncture site is by manual or mechanical compression.

The alternative to manual or mechanical compression is the placement of a collagen sponge, plug, and/or an absorbable suture at the arterial puncture site. Devices such as Angio-Seal, VasoSeal, Prostar, and Techstar may be utilized to achieve the necessary hemostasis.

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.

Policy Position Coverage is subject to the specific terms of the member’s benefit plan.

Any method of arterial puncture hemostasis is considered part of the angiography or interventional procedure and, therefore, is not payable separately. A participating, preferred, or network provider cannot bill the member separately for arterial puncture hemostasis.

Procedure Codes

G0269

The policy position applies to all commercial lines of business

Denial Statements

A network provider cannot bill the member for the non-covered service.

Links

Link to Provider Resource Center for the Medical Policy Update

06/1998, Arterial puncture hemostasis considered part of global fee

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

Qualified sign language interpreters

Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:

Qualified interpreters

Information written in other languages

If you need these services, contact the Civil Rights Coordinator.

If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.