Medicare AdvantageCoverageHigh impact
MA11.113k, Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound
Independence Blue Cross·Cardiology, Cardiothoracic Surgery, Vascular Surgery·Medical Policy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for percutaneous coronary intervention, coronary angiography, and arterial ultrasound procedures. This policy change affects coverage determinations and documentation requirements for cardiac procedures.
Action Required
By March 24, 2025: Billing team and providers must review updated medical necessity criteria for coronary interventions and angiography procedures. Update documentation templates in EMR to ensure compliance with new Medicare Advantage requirements. Verify that all cardiac procedure claims include appropriate medical necessity documentation to prevent denials.