Modifiedpriority healthPolicy 91495-R10

Carotid and Intracranial Artery Stenting

Medical necessity and coverage guidance for carotid artery stenting, extracranial vertebral artery angioplasty/stenting, and intracranial angioplasty/stenting for Priority Health members; includes applicability to product lines and management by TurningPoint for certain procedures.

Policy Summary

Payerpriority health

PolicyCarotid and Intracranial Artery Stenting

Policy CodePolicy 91495-R10

Change TypeTerminology updateTurningPoint operational clarification

Effective DateJun 1, 2025

Next Review DateN/A

Key ActionObtain TurningPoint authorization for percutaneous transcatheter extracranial vertebral or intrathoracic carotid stent placement via Priority Health Prism.

SourceLink

POLICY UPDATE CHANGES

Terminology changed from 'cover' to 'medically necessary' for alignment with the purpose of this medical policy.

Statement that percutaneous transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s) has been managed by TurningPoint Healthcare Solutions LLC since May 2024 and added Item I.D. for clarification.

>70% / >50%symptomatic stenosis thresholds (ultrasound / angiogram) for CAS

>70% / >60%asymptomatic stenosis thresholds (ultrasound / angiogram) for CAS

≥50%vertebral artery stenosis threshold

Since May 2024

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