Preauthorization required; IVL listed and not reasonable and necessary

Preauthorization is required for intravascular shockwave lithotripsy (IVL). IVL is listed in this policy and is considered not reasonable and necessary for all indications; prior authorization must be obtained before performing procedures using the listed IVL codes. Claims for IVL may be denied if preauthorization is not obtained or if the service is rendered for any indication.

• Policy states: “Intravascular Shockwave Lithotripsy is considered not reasonable and necessary for all indications…” [[6]]
• Policy header and title indicate preauthorization requirement for IVL procedures [[0]]
• Listed CPT/HCPCS codes that require preauthorization include CPT 92972 and HCPCS C1761, C7571, C9764–C9767, C9772–C9775 [[18]]

Prior authorization required for listed CPT/HCPCS codes

Obtain prior authorization for any procedure using the IVL CPT and HCPCS codes listed in this policy (e.g., CPT 92972; HCPCS C1761, C7571, C9764–C9767, C9772–C9775).

• CPT 92972: PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
• HCPCS: C1761, C7571, C9764, C9765, C9766, C9767, C9772, C9773, C9774, C9775

Request and document prior authorization

Ensure preauthorization is requested per policy before scheduling IVL; document the request and authorization number in the medical record to support medical necessity and claims processing.

• Document prior authorization decision and include authorization number on claim and in chart.
• Include procedure and diagnosis code pair when requesting authorization.

Failure to obtain preauthorization may trigger denial

If prior authorization is required but not obtained, claims may be denied. Confirm authorization requirements and code coverage before performing IVL procedures to avoid payment denial.

• Verify authorization status for the specific CPT/HCPCS codes listed in the policy.
• Do not rely on the policy alone as authorization—obtain formal preauthorization per plan rules.

Use Quick Code Search to check code pair approval status

Use the Quick Code Search tool to verify whether a procedure and diagnosis code pair will be approved, denied, or held for review; both a procedure and diagnosis code are required when checking code pairs.

• Enter the procedure code first, then the diagnosis code, then click “Add Code Pair.”
• If the codes are listed in this policy, the tool will show a dropdown indicating approval/denial/hold status.

Include listed CPT and HCPCS/C codes on claims

Include the policy-listed CPT and HCPCS/C codes on claims that describe intravascular lithotripsy and associated revascularization services to ensure accurate processing.

• Report CPT 92972 for percutaneous transluminal coronary lithotripsy (listed separately in addition to the primary procedure).
• Report applicable HCPCS C-codes (C1761, C7571, C9764–C9767, C9772–C9775) for IVL catheters and revascularization services.

Coverage stance: IVL not reasonable and necessary for any indication

IVL is considered not reasonable and necessary for all indications; claims for intravascular shockwave lithotripsy may be denied as not medically necessary regardless of coding.

• Policy statement: “Intravascular Shockwave Lithotripsy is considered not reasonable and necessary for all indications as the effectiveness of this procedure has not been established.”

Preauthorization requirement: obtain authorization before IVL

Do not perform IVL procedures without required preauthorization; lack of required preauthorization for intravascular lithotripsy procedures may trigger denial of the claim.

• Confirm and document preauthorization prior to performing procedures billed with the IVL CPT/HCPCS codes.
• Be aware that even with preauthorization, the service is listed as not reasonable and necessary in this policy.