Question Documentation of Percent Stenosis for Angioplasty

LMFOUTS

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Where can I find documentation that spells out the percentage of stenosis required to meet MN for transluminal angioplasties? For dialysis circuit interventions (CPT 36902), for example? Where are these guidelines located? Thank you.
 

thomas7331

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Criteria for medical necessity for any particular procedure would be a matter of payer policy - there usually isn't a standard guideline that would apply to all situations.

Here's a link to the LCD published by CGS for their Medicare jurisdiction - it specifies in the text that they consider hemodynamically significant stenosis to be "generally >/50 percent of the vessel diameter": L34062

Other payers may have different criteria - you'd have to search each payer's policy library to determine if they publish anything specific to these services.
 

LMFOUTS

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Criteria for medical necessity for any particular procedure would be a matter of payer policy - there usually isn't a standard guideline that would apply to all situations.

Here's a link to the LCD published by CGS for their Medicare jurisdiction - it specifies in the text that they consider hemodynamically significant stenosis to be "generally >/50 percent of the vessel diameter": L34062

Other payers may have different criteria - you'd have to search each payer's policy library to determine if they publish anything specific to these services.
Thanks so much! LCD L34062 was very helpful.
 
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