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12465 Results

Repair blood vessel with vein graft; lower extremity

Service Code
35256 (CPT) Repair blood vessel with vein graft; lower extremity
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Repair blood vessel with graft other than vein; neck

Service Code
35261 (CPT) Repair blood vessel with graft other than vein; neck
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Repair blood vessel with graft other than vein; upper extremity

Service Code
35266 (CPT) Repair blood vessel with graft other than vein; upper extremity
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Repair blood vessel with graft other than vein; intrathoracic, with bypass

Service Code
35271 (CPT) Repair blood vessel with graft other than vein; intrathoracic, with bypass
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Repair blood vessel with graft other than vein; intrathoracic, without bypass

Service Code
35276 (CPT) Repair blood vessel with graft other than vein; intrathoracic, without bypass
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Repair blood vessel with graft other than vein; intra-abdominal

Service Code
35281 (CPT) Repair blood vessel with graft other than vein; intra-abdominal
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Endovascular Repair of Aortic Aneurysm

Service Code
35286 (CPT) Repair blood vessel with graft other than vein; lower extremity
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Aortic aneurysms can develop anywhere along the length of the aorta, but three-fourths of aneurysms are located in the abdominal aorta. Thoracic aortic aneurysms, including those that extend from the descending thoracic aorta into the upper abdomen, account for one-fourth of aortic aneurysms.

Endovascular stent grafting of the vascular system has emerged as a therapeutic modality for aortic aneurysms. Their safety and efficacy has been explored in the treatment of thoracic aortic aneurysms, abdominal aortic aneurysms, and peripheral arterial aneurysms.

Endovascular graft repair is performed under general, spinal or regional anesthesia. During the procedure, a prosthetic endograft is introduced with radiographic guidance through the femoral artery, iliac artery or the abdominal aorta. The device is advanced to the aneurysm site, deployed, and attached to the normal aorta with a self-expandable stent system. While both thoracic and abdominal aneurysms can be surgically repaired using stents and grafts, these open procedures are associated with considerable morbidity and mortality. Endovascular repair was developed to provide a minimally invasive approach, using a catheter inserted through a small groin incision to place the stent/graft across the aneurysm site. Patients requiring aortic aneurysm artery repair often have very significant co-morbid conditions including cardiac, pulmonary, and renal disease or insufficiency, and the comorbidities significantly increase the risk for major perioperative complications following open surgical repair.

A thoracic aortic aneurysm (TAA) is a potentially life-threatening disorder involving a structural weakness of the aortic wall. Progressive arterial dilation and possible rupture may occur.

Standard treatment for thoracic aortic aneurysms is an open surgical resection and replacement of the diseased aorta with a graft.

An abdominal aortic aneurysm (AAA) is usually asymptomatic until it expands or ruptures.

Presence of a pulsatile abdominal mass is virtually diagnostic but is found in less than half of cases. Rupture is uncommon if aneurysms are less than 5 cm in diameter, but ruptures are dramatically more common for aneurysms greater than 6 cm in diameter. Without prompt intervention, ruptured aneurysms are often fatal.

Endovascular stent grafting for the repair of descending thoracic aorta (DTA) and AAA is an option for treatment of aneurysms and may be covered for patients who meet the required criteria.

Authorization Guidelines

See the Turning Point site for specific requirements

Reauthorization Guidelines

See the Turning Point site for specific requirements

Limits

Medicaid only covers one procedure per date of service

Exclusions

Do not report 33881, 33883 when extension placement converts repair to cover left subclavian origin. Use only 33880.

Do not report 33886 in conjunction with 33880, 33881.

Report 33886 once, regardless of number of modules deployed.

Do not report 33889 in conjunction with 35694.

Do not report 33891 in conjunction with 35509, 35601.

Report CPT codes 34812, 34820, 34833, 34844, as appropriate.

Do not report 34833 in addition to 34820.

Place of Service

Inpatient hospital, Outpatient hospital, Office

Additional Service Specifics

Codes 33880 through 33891 represent a family of procedures to report placement of an endovascular graft for repair of the aorta. These codes include all device introduction, manipulation, positioning and deployment. All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not reported separately.

Other Information

The following procedure codes, when applicable, are reported separately: 34812, 34820, 34833 through 34834, 35226, 35286, 36140, 36200 through 36218, 36245 through 36248

How to Submit

Please submit your request to Turning Point

Resources

Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision

Service Code
35301 (CPT) Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; superficial femoral artery

Service Code
35302 (CPT) Thromboendarterectomy, including patch graft, if performed; superficial femoral artery
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; popliteal artery

Service Code
35303 (CPT) Thromboendarterectomy, including patch graft, if performed; popliteal artery
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery

Service Code
35304 (CPT) Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel

Service Code
35305 (CPT) Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure)

Service Code
35306 (CPT) Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure)
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision

Service Code
35311 (CPT) Thromboendarterectomy, including patch graft, if performed; subclavian, innominate, by thoracic incision
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; axillary-brachial

Service Code
35321 (CPT) Thromboendarterectomy, including patch graft, if performed; axillary-brachial
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; abdominal aorta

Service Code
35331 (CPT) Thromboendarterectomy, including patch graft, if performed; abdominal aorta
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal

Service Code
35341 (CPT) Thromboendarterectomy, including patch graft, if performed; mesenteric, celiac, or renal
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; iliac

Service Code
35351 (CPT) Thromboendarterectomy, including patch graft, if performed; iliac
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; iliofemoral

Service Code
35355 (CPT) Thromboendarterectomy, including patch graft, if performed; iliofemoral
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

Thromboendarterectomy, including patch graft, if performed; combined aortoiliac

Service Code
35361 (CPT) Thromboendarterectomy, including patch graft, if performed; combined aortoiliac
Prior Authorization Required
Yes
Benefit Plan
Medicaid
Diagnosis Group
Physical Health

Authorization Guidelines

If your request is for OUTPATIENT services, please see the Turning Point site for specific requirements. If your request is for INPATIENT services, If your request is for INPATIENT services, please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.

Conditional Requirements

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.

How to Submit

If your request is for OUTPATIENT services, please submit the request to Turning Point. If your request is for INPATIENT services, please submit the request to Trillium.