Transcatheter Infusion Therapy

LCD Information Document Information Source LCD ID N/A LCD ID L34084 Original ICD-9 LCD ID Not Applicable LCD Title Transcatheter Infusion Therapy Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 09/04/2025 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations, and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Language quoted from Centers for Medicare and Medicaid Services (CMS). National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. CMS Publications:CMS Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15: Section 50:coverage criteria for drugs and biologicals, administered incident to a physician service. Coverage Indications, Limitations, and/or Medical Necessity 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. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

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.