4.0 POLICY
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.
5.0 EFFECTIVE DATES
5.1 November
1, 1996, for intracoronary stents.
5.2 April
24, 2003, for drug eluting stents.