March 1, 2022
Dear Provider,
Wellcare is reinforcing the prior auth review for Leg Stent Coding with an effective date as of March 1, 2022.
Summary of Policy:
Wellcare is reminding providers to provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which require a medical necessity review.
|
CPT Description |
CPT Code |
|
ILIAC REVASC |
37220 |
|
ILIAC REVASC W/STENT |
37221 |
|
FEM/POPL REVAS W/TLA |
37224 |
|
FEM/POPL REVAS W/ATHER |
37225 |
|
FEM/POPL REVASC W/STENT |
37226 |
|
FEM/POPL REVASC STNT & ATHER |
37227 |
|
TIB/PER REVASC W/TLA |
37228 |
|
TIB/PER REVASC W/ATHER |
37229 |
|
TIB/PER REVASC W/STENT |
37230 |
|
TIB/PER REVASC STENT & ATHER |
37231 |
What does this mean for providers?
Providers are currently required to submit all pertinent clinical records when submitting a prior authorization request for these 10 codes.
Providers can review posted payment policies at: www.wellcare.com/Florida/Providers/Medicare/Claims/Payment-Policy
We are here to help. Please contact your Network Representative for general inquiries regarding this program.
