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Revised Claims & Payment Policy: Leg Stent Coding Updates

March 1, 2022

Dear Provider,
Wellcare is reinforcing the prior auth review for Leg Stent Coding with an effective date as of March 1, 2022.

Summary of Policy:
Wellcare 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.

 

CPT Description

CPT Code

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

What does this mean for providers?

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

Providers can review posted payment policies at: www.wellcare.com/Florida/Providers/Medicare/Claims/Payment-Policy

We are here to help. Please contact your Network Representative for general inquiries regarding this program.

 

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Last Updated On: 3/1/2022
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