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Percutaneous Coronary Interventions

Percutaneous Coronary Interventions Page 1 of 9 UnitedHealthcare Medicare Advantage Policy Guideline Approved 03/11/2020 Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc. Percutaneous Coronary Interventions Guideline Number: Approval Date: March 11, 2020 Table of Contents Page POLICY SUMMARY .. 1 APPLICABLE CODES .. 2 PURPOSE .. 7 REFERENCES .. 7 GUIDELINE HISTORY/REVISION INFORMATION .. 8 TERMS AND CONDITIONS .. 9 POLICY SUMMARY Overview Percutaneous Coronary intervention (PCI), commonly known as Coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic (narrowed) Coronary arteries of the heart found in Coronary heart disease.

Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) (See the Medicare Advantage Policy Guideline for

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