37290 prior authorization | Premera Blue Cross of Washington
37290, Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty, 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 the atherectomy and angioplasty within the same artery, unilateral; complex lesion, initial vessel, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 37290
- Description
- Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty, 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 the atherectomy and angioplasty within the same artery, unilateral; complex lesion, initial vessel
- Source
- Clinical Review by Code List PBCWA, Pg 327 Original policy