37268 prior authorization | Premera Blue Cross of Washington
37268, Revascularization, endovascular, open or percutaneous, femoral and popliteal 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, each additional vessel (List separately in addition to primary code) These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 37268
- Description
- Revascularization, endovascular, open or percutaneous, femoral and popliteal 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, each additional vessel (List separately in addition to primary code) These criteria do not imply or guarantee approval.
- Source
- Clinical Review by Code List PBCWA, Pg 315 Original policy