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Claim & Payment Policy: Leg Stent Coding Updates

Date: 02/15/24

Iowa Total Care will be requiring prior authorization for the Leg Stent Coding codes below, with an effective date of
March 1, 2024.

Iowa Total Care is reminding providers to provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which require a medical necessity review (using InterQual criteria, which is outlined on our Clinical, Payment & Pharmacy Policies webpage under ‘Clinical Policies’).

CPT® Code

CPT Description

ILIAC REVASC

37220

ILIAC REVASC W/STENT

37221

FEM/POPL REVAS W/TLA

37224

FEM/POPL REVAS W/ATHER

37225

FEM/POPL REVASC W/STENT

37226

FEM/POPL REVASC STNT & ATHER

37227

TIB/PER REVASC W/TLA

37228

TIB/PER REVASC W/ATHER

37229

TIB/PER REVASC W/STENT

37230

TIB/PER REVASC STENT & ATHER

37231

Providers are currently required to submit all pertinent clinical records when submitting a prior authorization request for these ten (10) codes.

For questions or concerns, contact your Provider Relations Specialist or call Provider Services at 1-833-404-1061.

Thank you for your partnership in serving Iowa Total Care members.