August 2023 medical policy updates

Our Medical Advisory Committee (MAC), comprised of network physicians contracted with Priority Health, met this month and approved a series of medical policy updates. All updates are outlined in our policy updates webpage; below is a new policy we want to draw your attention to:

Supporting lower extremity atherosclerosis management

With our new medical policy, Intravascular Lithotripsy (#91639), we’re striving to maximize our providers’ ability to manage atherosclerosis of the lower extremities endovascularly. The policy will go into effect on October 23 and outlines the following coverage positions:

Services Coverage

C9764-C9767

Limb perfusion in the proximal lower extremities

Covered for all lines of business

C9772-C9775

Interventions in the distal aspect of the lower extremity

Not separately payable for Commercial and Medicaid, not medically necessary

Covered for Medicare

C1761

Catheter, transluminal intravascular lithotripsy, coronary

Not separately payable for Commercial and Medicaid

Covered for Medicare