37291 prior authorization | Premera Blue Cross of Washington
37291, 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, each additional vessel (List separately in addition to code for primary procedure 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
- 37291
- 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, each additional vessel (List separately in addition to code for primary procedure These criteria do not imply or guarantee approval.
- Source
- Clinical Review by Code List PBCWA, Pg 327 Original policy