December 2, 2021
Wellcare is implementing the following policy for Leg Stent Coding with an effective date as of January 4, 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. Additionally, Wellcare is implementing a clinical review requirement for providers to submit digital format ultrasounds (arterial Doppler ultrasounds) and angiograms along with the written physician reports for the procedures. Providers can use any of the following formats: DIGITAL FORMAT AND MAXIMUM SIZE.
|
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, plus reports of ultrasounds and angiograms when submitting a prior authorization request for these 10 codes. Beginning January 4, 2022, the only additional requirement is to ensure that digital records of ultrasounds and angiograms are included as well, while submitting the other clinical records to Wellcare for these 10 codes.
Providers can review posted payment policies at: https://www.wellcare.com/Maine/Providers/Medicare/Claims/Payment-Policy
We are here to help. Please contact your Network Representative for general inquiries regarding this program.
Sincerely,
Wellcare
