All PlansCoverageHigh impact
Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease
Blue Cross & Blue Shield of Mississippi·MS · Radiology, Cardiology, Vascular Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage criteria for percutaneous revascularization procedures (balloon angioplasty, stent procedures, atherectomy) for lower extremity peripheral arterial disease. Coverage requires functionally limiting claudication with inadequate response to structured exercise therapy, or treatment of chronic limb-threatening ischemia or acute limb ischemia. Lithotripsy procedures are considered investigational and not covered.
Action Required
Immediately: Billing team must implement new prior authorization requirements for all percutaneous revascularization procedures for lower extremity PAD. Verify patients meet coverage criteria: functionally limiting claudication with failed structured exercise therapy, OR chronic limb-threatening ischemia, OR acute limb ischemia. Do not bill lithotripsy procedures as they are considered investigational. Update encounter forms to ensure providers document structured exercise therapy attempts and functional limitations. Claims not meeting criteria will be denied.