37258 prior authorization | Premera Blue Cross of Washington
37258, Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform stent placement and angioplasty, when performed, within the same artery, unilateral; straightforward lesion, initial vessel, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 37258
- Description
- Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform stent placement and angioplasty, when performed, within the same artery, unilateral; straightforward lesion, initial vessel
- Source
- Clinical Review by Code List PBCWA, Pg 311 Original policy