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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 9.3
Intracoronary Stents
Issue Date:  July 8, 1998
Authority:  32 CFR 199.4(c)(2) and (c)(3)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
92980, 92981
G0290, G0291
Intracoronary stenting consists of coils or tubes that are positioned within the coronary vessel to provide support or “scaffolding” to the internal vessel architecture. Most stents are metallic coils or tubes and balloon expandable or self-expanding.
4.1  Coronary artery stenting may be cost-shared for the following indications as an adjunct to percutaneous transluminal coronary angioplasty:
4.1.1  To reduce the incident of restenosis; and
4.1.2  For acute or threatened vessel closure following balloon angioplasty.
4.2  Coronary artery stents are covered for treatment of saphenous vein narrowing with previous coronary angioplasty bypass grafting.
4.3  Intracoronary stents must have U.S. Food and Drug Administration (FDA) approval based on its specific intention.
5.1  November 1, 1996, for intracoronary stents.
5.2  April 24, 2003, for drug eluting stents.
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