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    v1.0.31
    OpenPayerPolicy UpdatesVascular/Cardiothoracic SurgeryRegence Carotid Stenting Coverage | OpenPayer
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    CurrentRegence BlueCross BlueShieldPolicy 93

    Extracranial Carotid Angioplasty and Stenting and Embolic Protection Devices

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    This policy governs coverage of extracranial carotid angioplasty, carotid artery stenting, and embolic protection devices for carotid artery dissection and carotid stenosis. It specifies when these services may be medically necessary, when they are investigational, and the information providers must submit for review.

    Policy Summary
    PayerRegence BlueCross BlueShield
    PolicyExtracranial Carotid Angioplasty and Stenting and Embolic Protection Devices
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateOctober 1, 2026
    Last ReviewSep 1, 2026
    Next Review DateSeptember 1, 2026
    Key ActionSubmit clinical documentation showing symptom history, stenosis percentage, qualifying ischemic events or nondisabling stroke, and applicable anatomic contraindications to carotid endarterectomy.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    80%Stenosis threshold without recent focal ischemic symptoms
    50%

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Stenosis threshold with qualifying symptoms or stroke
    120 daysMaximum symptom-to-treatment interval
    6Listed anatomic contraindications to CEA
    InvestigationalPermanent bilateral carotid protection devices

    Medical Necessity and Investigational Services

    Carotid artery dissection

    May be considered medically necessary when the following indication is present:

    Carotid artery dissection: Extracranial carotid angioplasty and stenting is performed for treatment of carotid artery dissection.

    Carotid stenosis with contraindication to carotid endarterectomy

    Covered when all of the following are met:

    Required criteria

    • Documented stenosis

      • Documented stenosis of at least 80%.≥ 80%
      • Documented stenosis of at least 50% with symptoms lasting less than 24 hours of focal ischemia, including transient ischemic attack or monocular blindness, occurring within the previous 120 days.≥ 50%; symptoms < 24 hours and within the previous 120 days
      • Documented stenosis of at least 50% with a nondisabling stroke.≥ 50% with nondisabling stroke

    • Anatomic contraindication to carotid endarterectomy

      • Tissue changes from prior extensive ipsilateral neck radiation.
      • Prior ipsilateral radical neck resection.
      • Anatomical malformation that prevents collateral circulation to the brain during open carotid endarterectomy.
      • Lesion is surgically inaccessible, such as a high internal carotid lesion that cannot be accessed from the neck.
      • Spinal immobility prevents open carotid endarterectomy.
      • Tracheostomy.

    Indications not meeting medical necessity criteria

    Investigational:

    Indications outside covered criteria: Extracranial carotid angioplasty is considered investigational for all indications that do not meet the carotid artery dissection criterion or the qualifying stenosis and anatomic contraindication criteria.

    Permanent bilateral common carotid embolic protection devices

    Investigational for all indications:

    Permanent bilateral common carotid embolic protection devices are considered investigational for all indications, including stroke prevention in patients with atrial fibrillation.

    Medically necessary CAS

    Covered when the applicable policy criteria are met:

    Medically necessary CAS indications

    • Carotid artery dissection.
    • Carotid artery stenosis in a selected higher-risk individual who should not undergo carotid endarterectomy and meets the applicable policy criteria.

    CAS not meeting criteria

    Investigational when the applicable policy criteria are not met:

    CAS outside covered criteria: Carotid artery stenting is investigational for individuals with carotid artery stenosis who do not meet the policy criteria identifying the selected higher-risk group for whom carotid artery stenting may improve outcomes compared with carotid endarterectomy.

    Permanent bilateral carotid embolic protection devices

    Not covered as medically necessary for any indication:

    Permanent bilateral common carotid embolic protection devices: Percutaneous placement of permanent bilateral common carotid embolic protection devices is investigational for all indications, including stroke prevention in patients with atrial fibrillation.

    No permanent bilateral common carotid embolic protection devices have received FDA approval, and current clinical guidelines do not address these devices.

    Medically Necessary Carotid Artery Stenting

    Carotid artery stenting is considered medically necessary when either of the following applies and the applicable policy criteria are met:

    Medically necessary CAS indications

    • Carotid artery dissection.
    • Carotid artery stenosis in an individual at higher risk for carotid endarterectomy who meets the policy criteria.

    Investigational Carotid Artery Stenting

    Carotid artery stenting is investigational when:

    Investigational CAS: The individual does not meet the policy criteria for a medically necessary carotid artery stenting indication.

    Permanent Bilateral Common Carotid Embolic Protection Devices

    Investigational for any indication:

    Permanent bilateral common carotid embolic protection device: Percutaneous placement of a permanent bilateral common carotid embolic protection device, including use for stroke prevention in an individual with atrial fibrillation.

    Current evidence-based clinical guidelines do not recommend these devices.

    Percutaneous angioplasty and stenting of veins is outside the scope of this policy and is addressed under a separate policy.

    Permanent bilateral common carotid embolic protection devices are excluded from medically necessary coverage for all indications, including stroke prevention in individuals with atrial fibrillation.

    Carotid artery stenting (CAS) for carotid artery stenosis is considered investigational, rather than medically necessary, when the individual does not meet the policy criteria.

    Percutaneous placement of permanent bilateral common carotid embolic protection devices is investigational for any indication, including stroke prevention in individuals with atrial fibrillation.

    Procedure and Supply Codes

    CPT CodesCPT
    1091TPlacement of permanent common carotid artery filter, percutaneous, bilateral, including ultrasound guidance, when performed.
    37215Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection.
    37216Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; without distal embolic protection.
    37217Transcatheter placement of an intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, via open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation.
    37246Transluminal balloon angioplasty, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery.
    37247Transluminal balloon angioplasty; each additional artery.
    HCPCS CodesHCPCS
    C7532Transluminal balloon angioplasty, initial artery, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation.
    C7563Transluminal balloon angioplasty, open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, initial artery and all additional arteries.
    C8010Percutaneous placement of permanent common carotid embolic protection device, including all system components and imaging guidance; bilateral (Deleted 10/01/2026).

    Authorization and Documentation Requirements

    Documentation Required

    Submit Clinical Records for Review

    Submit the clinical records below for review. Missing information could affect the medical-necessity review and decision outcome.

    • History and physical or chart notes
    • Current symptomology
    • Documentation of the percent of stenosis
    • Documentation of focal ischemia, including duration and date of occurrence, or documentation of a nondisabling stroke for symptomatic patients
    • Contraindications for carotid endarterectomy, including one or more contraindications listed in the policy
    Documentation Required

    Information Required for Medical Necessity Review

    Medical-necessity review requires documentation establishing the patient’s clinical history and symptoms, the degree of carotid stenosis, and focal ischemia or a qualifying nondisabling stroke. When applicable, submit documentation of one or more anatomic contraindications to carotid endarterectomy.

    Clinical Background

    Extracranial carotid angioplasty and stenting is a catheter-based procedure used to treat disease in a narrowed carotid artery. It involves balloon dilation of the artery followed by placement of a stent, generally with embolic protection intended to reduce the risk of thromboembolic stroke. The policy addresses its use for carotid artery dissection and selected individuals with carotid artery stenosis, including certain individuals at higher risk for carotid endarterectomy.

    Key Terms

    Extracranial carotid angioplasty/stenting (CAS)
    ProcedureInsertion of a wire-mesh stent into a narrowed extracranial carotid artery, with or without an embolic protection device.
    PurposeTreats carotid stenosis and is intended to prevent future stroke.
    TechniqueA catheter-guided balloon opens the narrowed area, and the metal stent is placed to help prevent recurrent narrowing.
    Embolic protection device (EPD)
    PlacementPlaced distally during carotid angioplasty and stenting.
    FunctionReduces the risk of stroke caused by thromboembolic material dislodged during the procedure.
    Policy Summary
    PayerRegence BlueCross BlueShield
    PolicyExtracranial Carotid Angioplasty and Stenting and Embolic Protection Devices
    Policy CodePolicy N/A
    Change TypeNo material change
    Effective DateOctober 1, 2026
    Last ReviewSep 1, 2026
    Next Review DateSeptember 1, 2026
    Key ActionSubmit clinical documentation showing symptom history, stenosis percentage, qualifying ischemic events or nondisabling stroke, and applicable anatomic contraindications to carotid endarterectomy.
    SourceLink
    On This Page
    Medical Necessity and Investigational ServicesProcedure and Supply CodesAuthorization and Documentation RequirementsClinical BackgroundKey Terms
  1. History and physical or chart notes
  2. Current symptomology
  3. Percent of stenosis
  4. For symptomatic patients: focal ischemia with duration and date of occurrence, or a nondisabling stroke
  5. Applicable carotid endarterectomy contraindications
    6. Denial Risk

    Investigational Indications or Device Use

    Extracranial carotid angioplasty is investigational for indications that do not meet the policy’s criteria for carotid artery dissection or qualifying carotid artery stenosis with the required clinical and anatomic circumstances.

    • Use outside the covered dissection indication is investigational
    • Use for carotid stenosis is investigational when the policy criteria are not met
    Denial Risk

    Permanent Bilateral Embolic Protection Devices

    Permanent bilateral common carotid embolic protection devices are investigational for all indications. This includes stroke prevention in patients with atrial fibrillation; the devices differ from temporary embolic protection used during carotid artery stenting.

    • Investigational for all indications
    • Includes stroke prevention in atrial fibrillation
    • No FDA-approved permanent bilateral common carotid embolic protection devices are identified in the policy rationale
    Denial Risk

    CAS Criteria Not Met

    Carotid artery stenting is investigational when the policy’s medical-necessity criteria are not met. CAS is not medically necessary outside the qualifying dissection or selected high-risk carotid stenosis criteria.

    • CAS outside policy criteria is investigational
    • CAS is investigational when the required medical-necessity criteria are not met
    Use with CAS
    Most practitioners use an embolic protection device during CAS; carotid angioplasty is rarely performed without stent placement.
    Permanent bilateral common carotid embolic protection device
    Implant locationPlaced bilaterally in the common carotid arteries.
    Placement methodInserted by direct transcutaneous puncture.
    Intended functionCaptures emboli originating from cardiac sources before they reach the brain.
    Coverage statusConsidered investigational for all indications, including stroke prevention in patients with atrial fibrillation.
    Carotid endarterectomy (CEA)
    DefinitionOpen surgical removal of carotid plaque.
    Prior ipsilateral neck treatmentAnatomic contraindications include tissue changes from prior extensive ipsilateral neck radiation or prior ipsilateral radical neck resection.
    Circulation or access limitationContraindications include an anatomical malformation preventing collateral circulation to the brain during open endarterectomy or a surgically inaccessible lesion, such as a high internal carotid lesion that cannot be accessed from the neck.
    Other listed contraindicationsSpinal immobility preventing open carotid endarterectomy and tracheostomy are also listed contraindications.
    Relevance to CAS coverageOne or more listed anatomic contraindications to carotid endarterectomy must be documented when seeking coverage for carotid angioplasty with associated stenting and embolic protection.