Does C1757 require prior authorization?

No, C1757 does not require prior authorization (high confidence). Covered without prior authorization.

`C1757`, Catheter, thrombectomy/embolectomy

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

(Inferred) For coronary or peripheral arterial use: documentation of vessel diameter ≥2.0 mm and that AngioJet thrombectomy is being performed prior to angioplasty or stent placement (policy text: 'prior to angioplasty or stent placement').
(Inferred) For lower-extremity DVT: clinical documentation showing failure of prior pharmacologic thrombolysis or documentation of contraindication to pharmacologic thrombolysis.
(Inferred) Appropriate diagnostic imaging or angiographic evidence of thrombus (angiography, CT, duplex ultrasound) supporting the indication for thrombectomy.
(Inferred) Procedure notes and coding to support use of an AngioJet catheter (e.g., HCPCS C1757) and the applicable CPT code(s) listed in the policy; linkage of performed procedure to a covered diagnosis code.

I82.401 - I82.4z9 Acute embolism and thrombosis of deep veins of lower extremity [deep vein thrombosis]
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
HCPCS code covered if selection criteria are met: C1757 Catheter, thrombectomy/embolectomy
Aetna considers the AngioJet Rheolytic Thrombectomy System, also known as the Possis AngioJet Rapid Thrombectomy System, medically necessary for the following:
For removing fresh blood clots from any of the following vessels:

AETNA-CPB-0568, Thrombectomy Systems

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