Wellcare is reinforcing the prior authorization review for Leg Stent Coding with an effective date as of May 2, 2022.
Summary of Policy:
Wellcare is reminding providers to provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which require a medical necessity review.
| CPT Description | CPT Code |
|---|---|
|
ILIAC REVASC ILIAC REVASC W/ STENT FEM/POPL REVAS W/TLA FEM/POPL REVAS W/ATHER FEM/POPL REVASC W/STENT FEM/POPL REVASC STNT & ATHER TIB/PER REVASC W/TLA TIB/PER REVASC W/ATHER TIB/PER REVASC W/STENT TIB/PER REVASC STENT & ATHER |
37220 37221 37224 37225 37226 37227 37228 37229 37230 37231 |
What does this mean for providers?
Providers are currently required to submit all pertinent clinical records when submitting a prior authorization request for these 10 codes.
Providers can review posted payment policies at: Wellcare.com/Texas/Providers/Medicare/Claims/Payment-Policy.
We are here to help. Please contact your Network Representative for general inquiries regarding this program.
