About this policy
Jurisdiction: J15 MAC Part B. States: Kentucky, Ohio. Type: Active LCD
Coverage indications
Abstract: For the purpose of this LCD, Transcatheter Therapy is defined as the infusion of medication (other than chemotherapy and thrombolysis) through an inserted arterial (angiographic) catheter for the purpose of delivering specific medication to a localized vascular bed. Therapeutic infusion of medications is covered for indications identified in the LCD, when other routes of administration are not appropriate or effective. The treatment is reimbursable as a single service, regardless of the duration of the infusion. Indications: Transcatheter infusion therapy is indicated for the prolonged therapeutic administration (infusion) of a medication through a previously inserted arterial angiographic catheter for the purpose of delivering the medication to an individual vascular bed. Such administration assumes that the drug could not be delivered effectively via any other route (e.g., sublingual, intravenous, intramuscular, subcutaneous, etc) and must be infused via the indwelling catheter to be effective. Infusion is defined as the prolonged, continuous administration of the medication through the catheter lasting a minimum of 30 minutes. It may require the use of an infusion pump. Bolus, "push" or "slow push" injections are not infusions. Transcatheter infusions may be indicated for the treatment of: cerebrovasospasm bleeding involving the head or neck gastrointestinal hemorrhage non-occlusive mesenteric ischemia. Raynaud's syndrome Medications for which infusion is a reimbursable service include: nitroglycerin (for cerebrovascular spasm, only) neosynephrine vasopressin somatastatin papaverine reserpine Limitations: Transcatheter administration of medications or other biologics for reasons other than treatment (e.g., medications administered for diagnostic purposes; contrast agents administered for imaging) and medications administered incidental to a diagnostic procedure, albeit for therapeutic reasons (e.g., nitroglycerin administered intra-coronary during coronary angiography), are not covered or reimbursable under this code. CPT codes for transcatheter infusion therapy is reimbursable only once per encounter, regardless of the number of medications infused or duration of the infusion beyond 30 minutes. Infusions for the treatment of primary pulmonary hypertension are considered investigational and will be denied as not medically necessary. Infusions for medications normally given by bolus or "push" technique or by another route will be denied as not medically necessary.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 37211 | CPT | Covered |
| 37212 | CPT | Covered |
| 37213 | CPT | Covered |
| 61650 | CPT | Covered |
| 61651 | CPT | Covered |
| G45.9 | ICD10CM | Covered |
| I60.01 | ICD10CM | Covered |
| I60.02 | ICD10CM | Covered |
| I60.11 | ICD10CM | Covered |
| I60.12 | ICD10CM | Covered |
| I60.2 | ICD10CM | Covered |
| I60.31 | ICD10CM | Covered |