CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Anastomosis of Extracranial‑Intracranial Arteries (EC‑IC bypass)

Defines coverage stance and coding for surgical anastomosis of extracranial to intracranial arteries (EC‑IC bypass) for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAnastomosis of Extracranial‑Intracranial Arteries (EC‑IC bypass)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date09|01 |2025

Next Review DateN/A

Key ActionCheck member benefits and eligibility per the subscriber or employer agreement before providing services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1Covered CPT code listed

1985 trialKey clinical trial referenced

5Policy notices

Coverage Criteria

Coverage statement

Covered when the procedure is being considered; however historical evidence does not support efficacy for ischemic cerebrovascular disease of the carotid or middle cerebral arteries.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAnastomosis of Extracranial‑Intracranial Arteries (EC‑IC bypass)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date09|01 |2025

Next Review DateN/A

Key ActionCheck member benefits and eligibility per the subscriber or employer agreement before providing services.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Use of extracranial–intracranial (EC‑IC) bypass to treat ischemic cerebrovascular disease of the carotid or middle cerebral arteries is considered not medically necessary because the EC/IC Bypass Study (1985) failed to confirm that surgical anastomosis provides superior prevention of cerebral ischemia compared with no surgical intervention. Consequently, there is insufficient evidence to support efficacy for carotid or middle cerebral artery atherosclerotic disease.

Provider Actions & Billing

Prior Authorization

Prior authorization requirement: Not applicable.

Note

Contract Variability

Benefits vary by contract. Check the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for coverage details and any applicable limits or exclusions.

Documentation Required

Benefits & Eligibility

Benefit and eligibility determination: Benefits and eligibility are determined by the member's subscriber agreement, member certificate, and/or the employer agreement; those documents supersede this medical policy. For member-specific benefit information, contact the provider call center.

Denial Risk

Denial Risk / Member Billing

Risk of denial for services determined not medically necessary: If services provided are determined to be not medically necessary (or are medically necessary but are non-covered benefits under the member's plan), the provider may be at risk for claim denial. Providers may not bill the member for such services unless the provider has informed the member in advance and obtained the member's written agreement to accept financial responsibility. Refer to your participation agreement(s) for applicable provisions.

If a service is denied as not medically necessary, do not bill the member unless prior written agreement exists.
Contact the provider call center for member-specific coverage questions.

Background

Intracranial atherosclerotic disease refers to narrowing or obstruction of intracranial arteries caused by atheromatous plaque and commonly presents with transient ischemic attack or stroke. Standard management emphasizes medical therapy and control of atherosclerotic risk factors. EC‑IC bypass is a surgical procedure intended to bypass narrowed segments to improve cerebral blood flow, but randomized trial data did not demonstrate that this approach reduces ischemic events for atherosclerotic disease of the carotid or middle cerebral arteries.

Definitions

EC‑IC anastomosis — definition

ProcedureSurgical craniotomy with dissection and anastomosis of extracranial and intracranial arteries

PurposeCreate an arterial bypass to restore or augment cerebral blood flow by connecting extracranial to intracranial arteries

Typical approachOpen neurosurgical procedure involving identification and microsurgical suturing of donor extracranial and recipient intracranial arteries

Common indication (context in policy)Considered for cerebrovascular conditions where bypass is being evaluated, though evidence does not support efficacy for ischemic disease of the carotid or middle cerebral arteries

Related CPT code61711 — Anastomosis, arterial, extracranial-intracranial (e.g., middle cerebral/cortical) arteries

OpenPayer

Anastomosis of Extracranial‑Intracranial Arteries (EC‑IC bypass)

Coverage Criteria

Coding

Provider Actions & Billing

Background

Definitions