Endovascular Repair - Stent for Abdominal Aortic Aneurysm
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MEDICAL POLICY – 2.02.513
Endovascular Repair – Stent for Abdominal Aortic
Aneurysm
Ref. Policy: MP-103
Effective Date: May 1, 2021 RELATED MEDICAL POLICIES:
Last Revised: April 1, 2021 None
Replaces: N/A
Select a hyperlink below to be directed to that section.
POLICY CRITERIA | CODING | RELATED INFORMATION
EVIDENCE REVIEW | REFERENCES | HISTORY
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Introduction
The aorta is the main blood vessel in the center of the body that runs from the heart up into the
chest and down into the abdomen. An abdominal aortic aneurysm (AAA) is caused by an
enlarged area toward the bottom of the aorta that fills with blood and bulges. Over time, the
pressure on this bulge can build up and rupture, causing pain, massive internal bleeding, and
death. Endovascular aneurysm repair is a treatment to repair ruptured or unruptured AAAs. A
long, thin tube called a catheter is inserted into an artery in the thigh and a woven fabric tube
covered with metal support (stent graft) is placed in the abdominal aorta. This policy describes
when endovascular aneurysm repair with a stent graft may be considered medically necessary.
Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The
rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for
providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can
be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a
service may be covered.
Policy Coverage CriteriaService Medical Necessity
Endovascular repair/stent Endovascular repair/stent for abdominal aortic aneurysm
for abdominal aortic (AAA) and/or its major branches may be considered medically
aneurysm (AAA) necessary for patients with aneurysms having morphology
suitable to repair when any of the following indications are
met:
• Aneurysmal dilatation ˃ 5 cm and ≥ twice the diameter of the
non-dilated proximal segment; or
• Any documented aneurysmal dilatation that has expanded in
size by 0.5 cm or more in 6 months; or
• Any symptomatic or ruptured aneurysm. The primary
symptoms are tenderness on palpation and/or pain that may
occur in the back, flank, groin, or abdomen. Other symptoms
are related to compression of nearby structures such as veins
or ureters; or
• Any AAA with an aneurysmal iliac component
Note: The above measurements should be obtained by computed tomography
(CT) and represent the minor axis on the axial CT or any measurement
perpendicular to the line of flow on a 3D reconstruction.
See Related Information below for Limitations.
Coding
Code Description
CPT
34701 Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube
endograft including pre-procedure sizing and device selection, all nonselective
catheterization(s), all associated radiological supervision and interpretation, all
endograft extension(s) placed in the aorta from the level of the renal arteries to the
aortic bifurcation, and all angioplasty/stenting performed from the level of the renal
arteries to the aortic bifurcation; for other than rupture (eg, for aneurysm,
pseudoaneurysm, dissection, penetrating ulcer)
34702 Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube
endograft including pre-procedure sizing and device selection, all nonselective
catheterization(s), all associated radiological supervision and interpretation, all
Page | 2 of 8 ∞Code Description
endograft extension(s) placed in the aorta from the level of the renal arteries to the
aortic bifurcation, and all angioplasty/stenting performed from the level of the renal
arteries to the aortic bifurcation; for rupture including temporary aortic and/or iliac
balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, traumatic disruption)
34703 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an
aorto-uni-iliac endograft including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, all endograft extension(s) placed in the aorta from the level of the renal
arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level
of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm,
pseudoaneurysm, dissection, penetrating ulcer)
34704 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an
aorto-uni-iliac endograft including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, all endograft extension(s) placed in the aorta from the level of the renal
arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level
of the renal arteries to the iliac bifurcation; for rupture including temporary aortic
and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm,
dissection, penetrating ulcer, traumatic disruption)
34705 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an
aorto-bi-iliac endograft including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, all endograft extension(s) placed in the aorta from the level of the renal
arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level
of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm,
pseudoaneurysm, dissection, penetrating ulcer)
34706 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an
aorto-bi-iliac endograft including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, all endograft extension(s) placed in the aorta from the level of the renal
arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level
of the renal arteries to the iliac bifurcation; for rupture including temporary aortic
and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm,
dissection, penetrating ulcer, traumatic disruption)
34707 Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft
including pre-procedure sizing and device selection, all nonselective catheterization(s),
all associated radiological supervision and interpretation, and all endograft
extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and
treatment zone angioplasty/stenting, when performed, unilateral; for other than
rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation)
Page | 3 of 8 ∞Code Description
34708 Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft
including pre-procedure sizing and device selection, all nonselective catheterization(s),
all associated radiological supervision and interpretation, and all endograft
extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and
treatment zone angioplasty/stenting, when performed, unilateral; for rupture including
temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm,
pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)
34709 Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal
to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac
aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-procedure sizing
and device selection, all nonselective catheterization(s), all associated radiological
supervision and interpretation, and treatment zone angioplasty/stenting, when
performed, per vessel treated (List separately in addition to code for primary
procedure)
34710 Delayed placement of distal or proximal extension prosthesis for endovascular repair
of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak,
or endograft migration, including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, and treatment zone angioplasty/stenting, when performed; initial vessel
treated
34711 Delayed placement of distal or proximal extension prosthesis for endovascular repair
of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak,
or endograft migration, including pre-procedure sizing and device selection, all
nonselective catheterization(s), all associated radiological supervision and
interpretation, and treatment zone angioplasty/stenting, when performed; each
additional vessel treated (List separately in addition to code for primary procedure)
34712 Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor,
screw, tack) and all associated radiological supervision and interpretation
34713 Percutaneous access and closure of femoral artery for delivery of endograft through a
large sheath (12 French or larger), including ultrasound guidance, when performed,
unilateral (List separately in addition to code for primary procedure)
34714 Open femoral artery exposure with creation of conduit for delivery of endovascular
prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral
(List separately in addition to code for primary procedure)
34715 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by
infraclavicular or supraclavicular incision, unilateral (List separately in addition to code
for primary procedure)
34716 Open axillary/subclavian artery exposure with creation of conduit for delivery of
endovascular prosthesis or for establishment of cardiopulmonary bypass, by
infraclavicular or supraclavicular incision, unilateral (List separately in addition to code
for primary procedure)
Page | 4 of 8 ∞Code Description
34808 Endovascular placement of iliac artery occlusion device (List separately in addition to
code for primary procedure)
34812 Open femoral artery exposure for delivery of endovascular prosthesis, by groin
incision, unilateral (List separately in addition to code for primary procedure)
34813 Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm
repair (List separately in addition to code for primary procedure)
34820 Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion
during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (List
separately in addition to code for primary procedure)
34833 Open iliac artery exposure with creation of conduit for delivery of endovascular
prosthesis or for establishment of cardiopulmonary bypass, by abdominal or
retroperitoneal incision, unilateral (List separately in addition to code for primary
procedure)
34834 Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (List
separately in addition to code for primary procedure)
34841 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a
fenestrated visceral aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including one
visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)
34842 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a
fenestrated visceral aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including two
visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
34843 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a
fenestrated visceral aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including three
visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
34844 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a
fenestrated visceral aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including four or
more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
34845 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic
disruption) with a fenestrated visceral aortic endograft and concomitant unibody or
modular infrarenal aortic endograft and all associated radiological supervision and
Page | 5 of 8 ∞Code Description
interpretation, including target zone angioplasty, when performed; including one
visceral artery endoprosthesis (superior mesenteric, celiac, or renal artery)
34846 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic
disruption) with a fenestrated visceral aortic endograft and concomitant unibody or
modular infrarenal aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including two
visceral artery endoprostheses (superior mesenteric, celiac, and/or renal artery)
34847 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic
disruption) with a fenestrated visceral aortic endograft and concomitant unibody or
modular infrarenal aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including three
visceral artery endoprostheses (superior mesenteric, celiac, and/or renal artery)
34848 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm,
pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic
disruption) with a fenestrated visceral aortic endograft and concomitant unibody or
modular infrarenal aortic endograft and all associated radiological supervision and
interpretation, including target zone angioplasty, when performed; including four or
more visceral artery endoprostheses (superior mesenteric, celiac, and/or renal artery)
Note: CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). HCPCS
codes, descriptions and materials are copyrighted by Centers for Medicare Services (CMS).
Related Information
Limitations
• The endovascular graft must be approved by the U.S. Food and Drug Administration (FDA)
for the treatment of the aneurysm
Evidence Review
Page | 6 of 8 ∞Background
According to the Society of Interventional Radiology (SIR), the occurrence of abdominal aortic
aneurysms (AAAs) has increased three-fold in the past 30 years and now affects as many as 8%
of the population over the age of 65. An AAA is caused by an enlarged area in the lower part of
the aorta, the major blood vessel that supplies blood from the heart to the rest of the body. An
aneurysm larger than 5 centimeters is usually considered for treatment to prevent rupture. Risk
factors related to rupture include the size of the AAA diameter, the rate at which it has
expanded, the patient age and smoking history. SIR reports that once an AAA has ruptured, the
survival chances are low, resulting in death for 80-90% of all ruptured AAA patients.
Endovascular aneurysm repair (EVAR) is used as an alternative to open surgery for the repair of
ruptured and unruptured AAAs. The repair involves the placement of an endovascular graft
within the abdominal aorta to reduce the pressure on the region. The placement is
accomplished via a delivery system inserted through the femoral arteries to the aneurysms
under fluoroscopic guidance. Once the graft is fixed to the aorta, the delivery system is then
removed.
References
1. ACCF/AHA Guideline: 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management
of Patients With Thoracic Aortic Disease. March 16, 2010. http://circ.ahajournals.org/content/121/13/e266.full. March 23,
2021.
2. Centers for Medicare and Medicaid Services (CMS). Local Coverage Article No. A53124: Endovascular Repair of Aortic
Aneurysms. (Contractor: Novitas Solutions) Revision Effective Date: 01/01/2020. https://www.cms.gov/medicare-coverage-
database/details/article-
details.aspx?articleId=53124&ver=34&name=331*1&UpdatePeriod=868&bc=AAAAEAAAAAAA& March 23, 2021.
3. Hayes Medical Technology Directory. Endovascular Repair of Abdominal Aortic Aneurysms. Annual Review Sep 13, 2017.
Archived: September 20, 2018
4. National Institute for Health and Clinical Excellence (NICE). Technology Appraisal Guidance No. 167. Endovascular stent-grafts
for the treatment of abdominal aortic aneurysms, Issue date: March 19, 2020 https://www.nice.org.uk/guidance/NG156
March 23, 2021.
5. Society of Interventional Radiology: Abdominal Aortic Aneurysms-interventional radiologists treat abdominal aneurysms
nonsurgically. © 2018. http://www.sirweb.org/patients/abdominal-aortic-aneurysms/ March 23, 2021.
6. U.S. Food and Drug Administration (FDA). Premarket Approval (PMA): ANCURE/Aortoiliac Endograft System. Applicant: Guidant
Cardiac and Vascular Surgery. PMA No. P990017/S030. Decision Date: April 24, 2002.
https://www.accessdata.fda.gov/cdrh_docs/pdf/P990017S030b.pdf March 23, 2021.
Page | 7 of 8 ∞7. U.S. Food and Drug Administration (FDA). Premarket Approval (PMA): AneuRx Stent Graft System. Applicant: Medtronic
Vascular. PMA No. P990020. Decision Date: September 28, 1999. Page Last Updates:07/27/2020.
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P990020 March 23, 2021.
History
Date Comments
09/16/19 New policy, approved August 13, 2019, effective January 1, 2020. Endovascular
repair/stent for abdominal aortic aneurysm (AAA) and/or its major branches may be
considered medically necessary for patients with aneurysms having morphology
suitable to repair when the indications meet this policy.
10/01/20 Annual Review, approved September 17, 2020. No changes to policy statement,
references updated. Updated code descriptions, removed CPT codes 75952 and 75953
which termed 1/1/2018.
05/01/21 Annual Review, approved April 1, 2021. No changes to policy statement, references
updated.
Disclaimer: This medical policy is a guide in evaluating the medical necessity of a particular service or treatment. The
Company adopts policies after careful review of published peer-reviewed scientific literature, national guidelines and
local standards of practice. Since medical technology is constantly changing, the Company reserves the right to review
and update policies as appropriate. Member contracts differ in their benefits. Always consult the member benefit
booklet or contact a member service representative to determine coverage for a specific medical service or supply.
CPT codes, descriptions and materials are copyrighted by the American Medical Association (AMA). ©2021 Premera
All Rights Reserved.
Scope: Medical policies are systematically developed guidelines that serve as a resource for Company staff when
determining coverage for specific medical procedures, drugs or devices. Coverage for medical services is subject to
the limits and conditions of the member benefit plan. Members and their providers should consult the member
benefit booklet or contact a customer service representative to determine whether there are any benefit limitations
applicable to this service or supply. This medical policy only applies to Individual Plans.
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