Transcatheter therapy is the administration of medication(s) via an indwelling vascular catheter for therapeutic purposes, or to enable further diagnostic tests following the therapeutic intervention. This LCD does not address thrombolysis, chemotherapy or embolization.
Transcatheter therapy is indicated for the prolonged infusion of a medication through a previously inserted angiographic catheter for the purpose of delivering the medication to an individual vascular bed, and when the drug cannot be delivered via any other route (e.g. sublingual, intramuscular, subcutaneous) to achieve its intended purpose or when the drug is more effective when infused via the indwelling catheter than any of the alternative routes of administration. It must be infused under the direct supervision of the billing physician.
CPT 37202, transcatheter therapy, is not an appropriate code to use in conjunction with billing for endovenous (either laser or radiofrequency) treatment of varicose veins. Billing of this code in such cases is incorrect and will subject the provider who so bills to postpay review.
For the purposes of this policy, infusion is defined as a controlled method of prolonged drug administration that includes the ability to control the administration rate. It may require the use of an infusion pump. Bolus, “push” or “slow push” injections are not infusions by this definition.
Transcatheter infusions may be indicated for the treatment of cerebrovasospasm, bleeding involving the head or neck, gastrointestinal hemorrhage, Raynaud’s syndrome or non-occlusive mesenteric ischemia.
Medications for which infusion is a reimbursable service include Pitressin (vasopressin), neosynephrine (phenylephrine hydrochloride), papaverine (papaverine hydrochloride), nitroglycerine, reserpine and somatostatin (Sandostatin, octreotide acetate). This list is not exclusive.
CPT 37202, transcatheter therapy, is not an appropriate code to use in conjunction with billing for endovenous (either laser or radiofrequency) treatment of varicose veins. Billing of this code in such cases is incorrect and will subject the provider who so bills to postpay review.
For the purposes of this policy, infusion is defined as a controlled method of prolonged drug administration that includes the ability to control the administration rate. It may require the use of an infusion pump. Bolus, “push” or “slow push” injections are not infusions by this definition.
Transcatheter infusions may be indicated for the treatment of cerebrovasospasm, bleeding involving the head or neck, gastrointestinal hemorrhage, Raynaud’s syndrome or non-occlusive mesenteric ischemia.
Medications for which infusion is a reimbursable service include Pitressin (vasopressin), neosynephrine (phenylephrine hydrochloride), papaverine (papaverine hydrochloride), nitroglycerine, reserpine and somatostatin (Sandostatin, octreotide acetate). This list is not exclusive.
Conditions, such as the following (not an exhaustive list) are excluded from coverage:
- Acute myocardial infarction.
- Chronic ischemic heart disease.
- Acute cor pulmonale.
- Atherosclerosis of aorta.
- Aneurysms.
- Thromboangiitis obliterans (buerger’s disease).
Compliance with the provisions in this policy is subject to monitoring by postpayment data analysis and subsequent medical review.
Limitations:
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
13X, 18X, 21X, 22X, 23X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances, Revenue Codes are purely advisory; unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD . Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/orRevenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual Publication 100-04, Claims Processing Manual, for further guidance.
033X, 036X
CPT/HCPCS Codes
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Note:
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Providers are reminded to refer to the long descriptors of the CPT codes in their CPT books. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
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37202©
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Transcatheter therapy infuse
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ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to procedure to diagnosis editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS code 37202:
Covered for:
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430
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Subarachnoid hemorrhage
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431
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Intracerebral hemorrhage
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432.0–432.1
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Other and unspecified intracranial hemorrhage
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432.9
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Unspecified intracranial hemorrhage
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435.9
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Unspecified transient cerebral ischemia
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443.0
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Raynaud’s syndrome
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456.0
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Esophageal varices with bleeding
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456.20
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Esophageal varices in diseases classified elsewhere with bleeding
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557.0
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Acute vascular insufficiency of intestine
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557.1
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Chronic vascular insufficiency of intestine
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557.9
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Unspecified vascular insufficiency of intestine
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578.9
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Hemorrhage of gastrointestinal tract unspecified
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Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses That Support Medical Necessity
N/A
ICD-9-CM Codes That DO NOT Support Medical Necessity
N/A
Diagnoses That DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.
