Medicare Coverage Policy

Coding, 2010 Carotid Artery Stenting (CAS) Quick Reference Guide: This guide provides coverage, coding and reimbursement information for carotid artery stenting procedures that utilize Boston Scientific products.

Coverage, Non-Medicare Coverage for Carotid Artery Stenting (CAS): Reference document with summary of non-Medicare coverage for carotid artery stenting. The Document was created in November 2009 with then-current coverage information found on the selected non-Medicare payer’s medical policy webpages.

Please Note: This information is accurate as of the date of print and is provided as a reference, and may change frequently and without notice. This information assumes, in each instance, that the procedure is medically necessary and otherwise appropriate for reimbursement and that all necessary documentation will be made available to the provider. Physicians may not rely on the compiled information as a promise or guaranty of coverage and Boston Scientific strongly suggests that facilities and physicians always confirm coverage status and all applicable requirements and restrictions with specific payers prior to performing CAS procedures

Coverage, Initial Application and Recertification for Eligibility for Medicare Reimbursement for Carotid Artery Stenting and List of Eligible Facilities:  This document reviews the processes and data submission requirements and timelines for seeking Medicare certification and recertification as a CAS facility.

Coverage, Template Initial Certification Letter for Facilities with Prior Clinical Trial Experience:  If your facility has CAS clinical trial experience and you would like to request inclusion on the list of facilities eligible for Medicare reimbursements for CAS procedures, please refer to this template for sample guidelines. See important information about the uses and limitations of this document at the top of the page.

Coverage, Template Initial Certification Letter for Facilities with No Clinical Trial Experience: If your facility does not have CAS clinical trial experience, but meets the minimum standards for facilities eligible for reimbursement for CAS procedures, as outlined in the CMS National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty (PTS) and CAS, and you would like to request inclusion on the list of Medicare-approved, please refer to this template for sample guidelines. See important information about the uses and limitations of this document at the top of the page.

Coverage, Medicare Data Submission Template: This submission template is intended as a guidance document only and must be tailored to address and include the specifics of your institution. It has been drafted in a form responsive to the requirements set forth in the Medicare National Coverage Determination for Carotid Artery Stenting and the Carotid Artery Stenting Facility Recertification Process described in the CMS webstie, both of which remain subject to change at any time and without notice.

Third Party Payers

Link to List of Medicare Approved Facilities: Click on this link to access the current list of facilities approved by Medicare to provide CAS to Medicare beneficiaries.

Coverage, Template Letter for Prior Approval/Medical Necessity: The following is a sample letter template that can be used for guidance by physicians when submitting claims to Medicare and when seeking prior authorization or submitting claims to non-Medicare payers. See important information about the uses and limitations of this document at the top of the page.