Does C1875 require prior authorization?

No, C1875 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C1875`, Stent, coated/covered, without delivery system

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For EC-IC bypass with parent artery occlusion: results of balloon test occlusion when performed to assess ischemic tolerance, pre-operative hemodynamic assessments (CBF/CBV/OEF or equivalent) when used for hemodynamic failure, and operative reports specifying bypass type (high-flow vs low-flow, graft used).
Peri-procedural and follow-up outcome documentation: NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores, procedural complications (stroke, intracerebral hemorrhage, death), and imaging follow-up (to assess occlusion, graft/stent patency, re-stenosis or re-canalization).
No documentation requirements are present in the provided document text.
Degree of carotid artery stenosis should be measured by duplex Doppler ultrasound or carotid artery angiography and recorded in the patient medical records.

First-stenting-without-retrieval (FRESH) technique (e.g., Solitaire FR first stenting) as a therapeutic option for ICAS-related emergent large vessel occlusion (single-center retrospective data showed favorable outcomes) (Kim et al 2021).
Extracranial-intracranial (EC-IC) bypass surgery for cerebral revascularization when parent vessel occlusion (for aneurysm treatment) cannot be tolerated or where revascularization is needed (e.g., complex/giant intracranial aneurysms, hemodynamic failure secondary to athero-occlusive disease) (Schaller 2008; Garrett et al 2009; Dubovoy et al 2017; Ishishita et al 2014; Zhang et al 2021).
High-flow EC-IC saphenous vein bypass grafting for treatment of complex intracranial aneurysms when indicated (retrospective series showing high graft patency and adequate cerebral blood flow) (Zhang et al 2021).
No coverage indications or clinical coverage criteria are present in the provided document text.
Percutaneous transluminal angioplasty of the extra-cranial carotid arteries, with or without stent implantation and embolic protection, in symptomatic individuals with at least 50 % stenosis of the carotid artery.
TCAR as a treatment option for high-risk carotid stenosis patients (Kashyap et al: "initial positive data with TCAR indicated that it may be an attractive alternative to trans-femoral carotid artery stenting and possibly CEA for high-risk patients").

AETNA-CPB-0276, Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures

AETNA-CPB-0621, Drug-Eluting Stents

AETNA-CPB-0625, Dysphagia Therapy

CARELON-percutaneous-coronary-intervention-2024-10-20-updated-2026-01-01, Percutaneous Coronary Intervention

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