Lower Extremity Endovascular Procedures (for North Carolina Only)
Coverage policy for endovascular revascularization procedures of the lower extremities (excluding upper extremities) for UnitedHealthcare members in North Carolina, describing when procedures are medically necessary or not.
Revised medically necessary coverage criteria to require imaging results of the target vessel show anatomic location and a moderate-severe stenosis (50% or greater) instead of prior wording referencing stenosis ≥50% generically.
Added that retreatment for in‑stent restenosis is proven and medically necessary when recurrent symptoms, impaired ADLs/work, and imaging of the previously treated vessel show moderate‑severe stenosis (≥50%); if duplex ultrasound is non‑diagnostic, another modality is required.
Clarified medical records documentation requirements used for reviews, including examples of required documentation and statement that documentation may be required but does not guarantee coverage.
Updated Clinical Evidence and References sections and archived previous policy version CSNCT0602.03.
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