Authorization pathway — TurningPoint lookup

Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stents is managed by TurningPoint Healthcare Solutions LLC; use Priority Health Prism → Authorizations → Authorization Criteria Lookup to access TurningPoint and determine authorization requirements.

• Authorization pathway for extracranial vertebral/intrathoracic stents managed by TurningPoint via Priority Health Prism.

Prior authorization — none indicated in device listings

This regulatory listing and device clearance sections do not specify a standing prior‑authorization rule for the devices listed; when prior authorization is required it will be identified via Priority Health Prism or plan‑specific documentation.

• No explicit prior authorization requirement stated in the FDA device/K‑number listings.

Prior authorization not specified in this excerpt

The device regulatory excerpts list FDA 510(k)/K‑number clearances but do not state a provider prior‑authorization workflow; check Priority Health Prism for any procedure‑ or plan‑specific authorization requirements.

• Regulatory device listings include K092177, K072990, K063313 and others but do not define prior authorization.

Prior authorization — none specified (device listings)

The regulatory device section enumerates multiple FDA K‑numbers and device names without a stated prior authorization requirement; treat these listings as informational and follow Prism for authorization rules.

• FDA K‑numbers and device names listed are informational; authorization status must be verified in Priority Health systems.

FDA device clearances — informational only

FDA device clearances are presented for informational purposes in the regulatory listing; the document does not establish prior authorization mandates for the named devices.

• Clearance entries (e.g., Emboshield NAV6 K191173, ACCUNET K153086) are informational and not an authorization instruction.

Document device-specific FDA 510(k) K‑numbers

The document lists specific FDA 510(k)/K‑numbers (examples include K191173, K141678, K121015, K110909, K090665, K081523, K052454, K153086, K111010, K063204, K052659, K062531, K101651, K052165, K042908, K042218) that should be cited in device identification and claims when relevant.

• Cite the exact FDA K‑number(s) associated with the embolic protection device used (examples shown above).
• Device K‑numbers are listed across the regulatory section and should be included in documentation when relevant to coding or review.

Prior authorization — none specified for embolic protection systems

The regulatory listings for embolic protection systems do not include a standing prior authorization requirement; they provide device clearances and identifiers only.

• Emboshield NAV6, ACCUNET, SPIDERFX and related K‑numbers are listed without authorization instructions.

Determine prior authorization via Priority Health Prism

Prior authorization may be required for certain procedures or devices; providers should use Priority Health Prism Authorization Criteria Lookup to access InterQual or TurningPoint guidance and submit medical‑necessity documentation when required.

• Use Priority Health Prism → Authorizations → Authorization Criteria Lookup to determine if prior authorization is required.
• When required, submit documentation demonstrating medical necessity per InterQual or TurningPoint criteria.

Use and document InterQual criteria for medical necessity

Medical necessity and prior authorization determinations for carotid and intracranial procedures are governed by the applicable InterQual clinical criteria referenced in this policy; document which InterQual criteria were applied.

• Use the InterQual ‘Angioplasty and Stent, Carotid or Vertebral’ and ‘Endovascular Intervention, Intracranial’ criteria as applicable.
• Record the specific InterQual criteria and results used to support medical necessity in the authorization or claim documentation.

Document baseline medical management prior to invasive therapy

Standard medical management (antiplatelet therapy, blood pressure and lipid control, and lifestyle measures) is described as the baseline approach when clinically appropriate prior to invasive revascularization.

• Ensure conservative/medical therapy has been considered and documented where clinically appropriate prior to stenting.
• Document antiplatelet regimen, BP and lipid control efforts, and lifestyle counseling when relevant to medical‑necessity review.

Step therapy — none specified

No step‑therapy requirements are specified in the policy text or regulatory device listings.

• The policy and device sections do not impose step‑therapy rules; follow InterQual and plan benefit requirements instead.

Confirm member benefits and CMS guidance in documentation

Follow member benefit terms and applicable CMS NCD/LCD guidance; document that the patient’s coverage permits the requested service because group‑specific plan documents may supersede this policy.

• Confirm member benefits and plan‑specific provisions before requesting authorization.
• Include references to applicable CMS NCD/LCDs when relevant to Medicare members (e.g., PTA NCD 20.7).

Document device identification and FDA K‑number on records/claims

Regulatory device listings should be recorded in clinical and coding records when relevant: document the specific device used and the corresponding FDA K‑number on claims and in the medical record.

• When an embolic protection device is used, record the device name and its FDA K‑number (examples: Emboshield NAV6 K191173; ACCUNET K153086).
• Include device identification in operative notes and billing records if device‑specific review or coding depends on it.

Submit medical‑necessity request and seek prior plan approval for investigational care

When prior authorization is required, submit a request demonstrating medical necessity; individual case review may allow coverage for investigational treatments only with prior plan approval and review by a Priority Health medical director or clinical pharmacist.

• Requests for investigational or unproven treatments require prior plan approval and review by Priority Health clinical leadership.
• Provide complete medical rationale and InterQual or TurningPoint documentation when seeking individual consideration.

Denial risk — investigational/individual review required

Requests for experimental, investigational, or unproven treatments will be denied unless prior plan approval via individual case review is obtained; all such determinations are made by a Priority Health medical director or clinical pharmacist.

• Do not bill or assume coverage for investigational procedures without prior plan approval.
• Individual case review is required for exceptions to investigational exclusions.

Denial risk — non‑adherence to InterQual criteria

If the applicable InterQual criteria are not met, the procedure would not satisfy this policy's medical necessity condition and may be denied.

• Document which InterQual criteria were evaluated and include supporting clinical data to avoid denials tied to InterQual adjudication.
• Procedures failing InterQual criteria are at risk for denial.

Device listings are informational — no documentation mandates stated

No provider‑level authorization or documentation requirements are specified within the raw FDA device/K‑number listings; those chunks are informational device clearances only.

• Device listings (FDA K‑numbers and dates) do not prescribe documentation workflows; follow policy sections on authorization and documentation for requirements.

Denial risk — intracranial vasospasm balloon dilatation is investigational (CPT 61640‑61642)

The regulatory excerpts reiterate that percutaneous balloon dilatation of intracranial vasospasm is considered investigational/experimental and listed CPT codes 61640–61642 are identified as not medically necessary.

• Do not submit claims expecting coverage for CPT 61640, 61641, 61642 without prior plan approval; these are listed as not medically necessary.
• If pursuing individual consideration, obtain prior plan approval and document clinical justification.

Document the specific InterQual/TurningPoint criteria used in authorization requests

When using Priority Health Prism for authorizations, document the specific InterQual or TurningPoint guideline page or criteria used to support the request.

• Include the InterQual criteria name (e.g., 'Angioplasty and Stent, Carotid or Vertebral' or 'Endovascular Intervention, Intracranial') in authorization submissions.
• Attach the InterQual decision output or relevant clinical fields to the prior‑authorization request.

Verify eligibility and plan benefit limitations

Benefit limitations and group‑specific plan documents may override this policy; confirm eligibility and benefit coverage before performing or billing for the procedure.

• Verify coverage via benefits and eligibility prior to scheduling procedures.
• Include plan‑specific references in the authorization or claim when relevant.