![]() ![]() Diagnosis and treatment of functional popliteal artery entrapment syndrome.Evaluation of chronic venous obstruction/venous stenting.During endovascular interventions of failing hemodialysis access grafts.Diagnosis / evaluation of pulmonary hypertension.For any of the following (not an all-inclusive list) because its use for these indications has not been validated by clinical studies:.Screening for coronary artery disease, diagnosing coronary vulnerable plaques, and its use in other coronary procedures. ![]() For the treatment of type B aortic dissection with thoracic endovascular aneurysm repair when assessment via CT was compromised by poor image quality or was otherwise inconclusive.Īetna considers the clinical application of IVUS for the following indications experimental and investigational because the effectiveness of this approach has not been established:.Diagnosis and follow-up of treatment of iliac vein compression syndrome (May-Thurner syndrome) of the lower extremity or.As a method for evaluation of cardiac allograft vasculopathy in post-cardiac transplantation recipients or.As a method for both guidance of placement of endoluminal devices and immediate assessment of the results of intracoronary interventional procedures (i.e., angioplasty, atherectomy, stenting), including those performed on coronary grafts or.As a guidance for placement of vena caval filter or.As a conclusive study to assess suspected left main stem coronary artery disease not revealed by coronary angiography or.As a clinical decision-making tool to evaluate the need for an intracoronary interventional procedure in a symptomatic member whose angiogram shows 50 to 70 % stenosis(es) or.This Clinical Policy Bulletin addresses intravascular ultrasound.Īetna considers intravascular ultrasound (IVUS) medically necessary for any of the following situations: Number: 0382 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References ![]()
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