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Prior Authorization Codes for Leg Stents and Related Services

November 1,2023

Wellcare of North Carolina is adding the following codes for leg stents and related services to prior authorization, effective 1/1/2024, for our North Carolina Medicaid and Medicare Advantage health plans. These services will be reviewed based on nationally recognized, evidence-based clinical practice guidelines.

To facilitate efficient prior authorization, please provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which will require a medical necessity review.

CPT Description

CTP 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

 

Information on submitting prior authorizations to Wellcare may be found at provider.wellcare.com, in our Wellcare of North Carolina Provider Manual, and in our Wellcare of North Carolina Quick Reference Guide.

We are here to help. Please contact your Provider Relations Representative at ncproviderrelations@wellcare.com for questions regarding this program.

 

 

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Y0020_WCM_134133E Last Updated On: 11/2/2023