Appeal type: Surgery
Decision: Partially Favorable

 
We decided that the Plan has to pay for 36220. We decided that the Plan does not have to pay for 37220 and 
37222.  
 
You asked the Plan to pay for procedure codes 36620, 37220, 37222 provided to the enrollee on August 5, 
2022.. You say that this should be paid for. The Plan says that the records do not support the services billed. 
 
We decided that the Plan has to pay for 36220.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of CPT 36220 is "Arterial catheterization or cannulation for 
sampling, monitoring or transfusion (separate procedure); percutaneous."  
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 36220. Our reviewer says that placement of 
the radial arterial monitoring line catheter is not a component of endovascular aortic repair and is, therefore, 
separately billable.  
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
36220.  
 
We also decided that the Plan does not have to pay for 37220 and 37222. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of the still denied codes is: 
 
CPT 37220: 
 
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal 
angioplasty 
 
CPT 37222: 
 
Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with 
transluminal angioplasty (List separately in addition to code for primary procedure) 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 37220 and 37222. Our doctor found that CPT 
34705 was previously approved and covered. This codes for aortobiliac endograft repair and this code includes 
all interventions including angioplasty and stenting within the treatment zone. As the treatments in question 
were performed within the treatment zone of the endograft, they cannot be separately billed. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 37220 and 37222 have not been met. Therefore, we decided that the Plan does 
not have to pay for 37220 and 37222. 
 
If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.