Medicare will cover intracranial percutaneous angioplasty (PTA) with stenting effective February 5, 2007. MLN Matters #MM5432 released on January 5, 2007 explains the changes in Medicare policy regarding reimbursement for PTA. Coverage will be effective as of November 6, 2006 for a PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis greater than equal to 50% in patients with intracranial atherosclerotic disease when furnished in accordance with FDA-approved protocols. The key points announced in the MLN Matters article are as follows:

§      Providers billing FIs and A/B MACs should note this coverage applies to claims with:

·        A discharge date on or after November 6, 2006;

·        ICD-9-CM procedure codes of 00.62 and 00.65 both being present;

·        ICD-9-CM diagnosis code 437.0 present; and

·        The IDE number present on a 0624 revenue code line.

§      Non-institutional providers billing Medicare carriers or A/B MACs should note this coverage applies to claims with:

·        CPT code 37799 (Unlisted procedure, Vascular surgery);

·        A QA modifier to denote Category B IDE clinical trial; and

·        The appropriate IDE number.

For full information on the transmittals can be obtained from the CMS website at the following two link: