January 01, 2022

Notice of change to review process related to cardiovascular codes that require prior authorization codes

Effective April 1, 2022, we will implement a new claim review process for outpatient facility claims with cardiovascular codes that require prior authorization for Medicare Advantage members.

The new process identifies services and procedures associated with cardiovascular codes that have a prior authorization denial or missing prior authorization.

If a prior authorization is not received or a prior authorization request for a specific code is denied, the entire outpatient facility claim will be denied.

Important information
It is important that health care providers secure all required prior authorizations before performing procedures and that outpatient facilities confirm receipt of those authorizations prior to performing the procedure(s). Outpatient facilities should confirm that health care providers secure the appropriate prior authorizations prior to procedure date.

Questions?
Call UnitedHealthcare Provider Services at 877-842-3210.

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ICD Procedure Code Description
Cardiovascular Prior Authorization Codes

37220

LEVI- Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

37221

LEVI- Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37224

LEVI- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty

37225

LEVI- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed

37226

LEVI- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37227

LEVI- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

37228

LEVI- Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty

37229

LEVI- Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed

93656

Catheter Ablations AFIB- Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation

93653

Catheter Ablations SVT- Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry

75710

LEVA- Angiography, extremity, unilateral, radiological supervision and interpretation

75716

LEVA- Angiography, extremity, bilateral, radiological supervision and interpretation

CPT Code Description

33285

Under Introduction or Removal of Subcutaneous Cardiac Rhythm Monitor

CPT® is a registered trademark of the American Medical Association
HCPCS Code Description

E0616

Implantable cardiac event recorder with memory, activator and program

PCA-1-21-01835