Currentblue cross blue shield - kansasPolicy N/A

Enhanced External Counterpulsation (EECP)

Outlines coverage history, coding, utilization, and clinical context for outpatient enhanced external counterpulsation (EECP) / external counterpulsation (ECP) therapy for disabling/refractory angina and heart failure; includes policy clarifications (e.g., repeat EECP review) and references.

Policy Summary

Payerblue cross blue shield - kansas

PolicyEnhanced External Counterpulsation (EECP)

Policy CodePolicy N/A

Change TypeHistorical clarifications and coding updates (utilization, outpatient limits, repeat treatment review, coding removals, archived)

Effective DateNovember 1, 2007

Next Review Date

Key ActionAny request for repeat EECP must be reviewed prior to approval; repeat treatments are not automatically approved.

POLICY UPDATE CHANGES

Any request for repeat EECP must be reviewed.

Policy liberalized from experimental/investigational to medically necessary for disabling angina (NYHA class III or IV) refractory to maximum medical therapy and not amenable to surgical intervention.

Policy guideline specifies outpatient uses only for chronic stable angina or heart failure and excludes unstable angina, acute MI, and cardiogenic shock.

Removed ICD-9 codes from Coding section.

Removed ICD-10 codes from Coding section.

Policy archived (document shows 'Archived' on 06-27-2024 line).

2Primary outpatient indications referenced

3+Major guideline/agency references cited

2005-2024Revision history span (years)

Coverage Summary

This policy addresses outpatient enhanced external counterpulsation (EECP/ECP), a noninvasive outpatient therapy used to augment diastolic pressure, decrease left ventricular afterload, and increase venous return for individuals with refractory/disabling angina or heart failure. EECP is defined here as an outpatient noninvasive therapy for refractory angina or heart failure (EECP/ECP). The document outlines coverage history, coding and utilization clarifications, and literature reviews used to evaluate EECP for chronic stable angina and chronic heart failure.

Status: CURRENT. Revision history records key coverage changes: effective 2005-09-21 the policy was liberalized from investigational to medically necessary for disabling angina (NYHA class III or IV) refractory to maximal medical therapy and not amenable to surgical intervention; 2007-11-01 added the requirement that any request for repeat EECP must be reviewed; 2015-03-18 clarified this policy applies to outpatient uses only and excludes unstable angina, acute myocardial infarction, and cardiogenic shock. The document shows an "Archived" line dated 06-27-2024 in the change log.

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Utilization and Coverage Criteria

Utilization / Coverage Notes (historical actions reflected)

Policy-level utilization and coverage clarifications recorded in the revision history and policy guidance:

ALL of the following

Policy liberalized from experimental/investigational to medically necessary for disabling angina (New York Heart Association class III or IV), refractory to maximum medical therapy, and not amenable to surgical intervention.
Effective 2005-09-21 per Medical Director
Any request for repeat EECP must be reviewed.
Added/clarified 2007-11-01 and moved to Utilization section 2013-06-26
This policy addresses outpatient uses of EECP for chronic stable angina or heart failure and excludes use for unstable angina, acute myocardial infarction, or cardiogenic shock.
Policy guideline added 2015-03-18
An office visit will not be allowed in addition to G0166 and 92971 (removed from Utilization section).
Removed 2013-06-26

Not Covered / Exclusions & Limits

The policy specifically excludes acute presentations: it does not address or allow EECP for unstable angina, acute myocardial infarction, or cardiogenic shock, and its guidance applies only to outpatient treatment of chronic stable angina or heart failure. Providers are instructed to document that the indication is for outpatient chronic stable angina or heart failure and not for the excluded acute conditions.

Repeat courses are not automatically approved: any request for repeat EECP must be reviewed prior to approval and is subject to utilization review rather than automatic coverage. This ties to provider actions requiring prior review of repeat treatments and documentation of outpatient indication; billing guidance (historic) on claims combinations such as G0166 and 92971 has also been updated and may affect claim adjudication.

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Coding

HCPCS / Related codes mentioned in Utilization (historic)HCPCS

G0166	External counterpulsation, per treatment session
92971	Cardioassist-method of circulatory assist; external

Provider Actions & Billing Rules

Prior Authorization

Review required for repeat EECP

Any request for repeat EECP must be reviewed prior to approval; repeat treatments are not automatically approved.

Repeat EECP requests require review before approval.

Documentation Required

Limit outpatient indications

EECP coverage guidance applies only to outpatient treatment for chronic stable angina or heart failure; providers should document that the indication is not unstable angina, acute MI, or cardiogenic shock.

Document that the indication is not unstable angina, acute myocardial infarction, or cardiogenic shock.

Background & Evidence

Enhanced external counterpulsation (EECP/ECP) is a noninvasive treatment that uses timed, sequential inflation of pressure cuffs on the calves, thighs, and buttocks to augment diastolic pressure, reduce left ventricular afterload, and increase venous return. A full course typically consists of 35 one-hour treatments, often delivered once or twice daily about five days per week, with monitoring components such as electrocardiography, plethysmography, and optional pulse oximetry.

EECP has been studied primarily for individuals with refractory/chronic stable angina and for heart failure. Evidence includes randomized trials and registry studies assessing physiologic measures (for example, time to ST-segment depression, collateral flow, and exercise tolerance) and clinical outcomes (symptoms, exercise capacity, quality of life), but results across studies have been mixed and methodologically limited, informing the policy's cautious stance and utilization constraints.

Revision History

2005-09-21revised

Effective 09-21-2005: Policy liberalized from experimental/investigational to medically necessary for disabling angina (NYHA class III or IV), refractory to maximum medical therapy, and not amenable to surgical intervention (per Medical Director).

2007-11-01clarified

Effective 11-01-2007: Policy clarified by adding 'Any request for repeat EECP must be reviewed.' (moved into Utilization section later).

2013-06-26clarified

06-26-2013: Statement 'Any request for repeat EECP must be reviewed.' moved into the Utilization section; Utilization section updated (removed allowance for an office visit in addition to G0166 and 92971); Description, Rationale, References and disclaimers updated.