Notification



Notification Issue Date:



Medical Policy Bulletin


Title:External Counterpulsation (ECP)

Policy #:07.02.05j

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

External counterpulsation (ECP) is considered medically necessary and, therefore, covered for individuals who meet all of the following criteria:
  • The individual has been diagnosed with disabling (Class III or IV of the Canadian Cardiovascular Society Classification [see the Guidelines section of this policy for further information] or equivalent classification) chronic stable angina pectoris.
  • A cardiologist or cardiothoracic surgeon has determined that the individual is not an appropriate candidate for surgical intervention (e.g., balloon angioplasty, cardiac bypass surgery) because of any of the following:
    • The individual's condition is inoperable.
    • The individual is at high risk of operative complications or post-operative failure.
    • The individual's coronary anatomy is not readily amenable to such procedures.
    • The individual has comorbid states that create excessive risk.

A single course of treatment (up to 35 sessions) is considered medically necessary and, therefore, covered. Continued treatment beyond a single course of 35 sessions is considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support its use in the treatment of illness or injury.

All other uses (e.g., heart failure, cardiogenic shock, acute myocardial infarction, ischemic stroke, erectile dysfunction, retinal artery occlusion, restless leg syndrome) of ECP are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support its use in the treatment of illness or injury.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Providers must report ECP using Healthcare Common Procedure Coding System (HCPCS) code G0166. The following services are included in G0166 and must not be reported separately:
  • External cardiac assist
  • Electrocardiograms
  • Bioimpedance thoracic, electrical
  • Pulse oximetry
  • Plethysmography, total body
  • Noninvasive physiologic studies of extremity arteries
  • Noninvasive physiologic studies of extremity veins
  • Application of a modality to one or more areas; vasopneumatic devices

Because the above listed services are considered components of ECP, they should not be paid on the same date of service, unless they occur in a clinical setting unrelated to the delivery of ECP.

Daily evaluation and management (E&M) services are mutually exclusive to ECP except when performed for a condition other than that for which the individual received ECP. In these cases, Modifier 25 must be reported.

Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
Guidelines

External counterpulsation (ECP) treatment should be ordered by a cardiologist or cardiothoracic surgeon. The individual should undergo a documented cardiac work-up within two to four months of commencing ECP treatments.

CANADIAN CARDIOVASCULAR SOCIETY CLASSIFICATIONS

I. Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina occurs with strenuous, rapid, or prolonged exertion during work or recreational activity.

II. Slight limitations of ordinary activity by angina. Angina pectoris occurs when walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold or in wind, under emotional stress, or only during the few hours after awakening. Angina pectoris may also occur when walking more than two blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions.

III. Marked limitation of ordinary physical activity. Angina pectoris occurs when walking one to two blocks on the level and climbing one flight of stairs in normal conditions and at a normal pace.

IV. Inability to carry on any physical activity without anginal discomfort. Angina may be present at rest.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, ECP is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for ECP.
Description

External counterpulsation (ECP) is a noninvasive procedure used to treat individuals with disabling (Class III or IV of the Canadian Cardiovascular Society Classification), chronic, stable angina pectoris; angina in individuals who are not suitable candidates for standard therapies (e.g., balloon angioplasty, cardiac bypass surgery); and individuals with ischemic coronary artery disease that has failed aggressive medical and/or surgical treatment. For these individuals, ECP has been shown to reduce symptoms and enhance quality of life.

ECP is aimed at increasing blood flow and improving exercise tolerance while decreasing chest pain. ECP uses pneumatic cuffs that are wrapped around the individual's calves, thighs, and lower abdomen. The cuffs rapidly and sequentially inflate when the heart enters its resting phase (diastole), and then deflate just before the heart's next contraction (systole). This action appears to improve myocardial perfusion and reduce cardiac workload and oxygen requirements. As a result of this treatment, most individuals experience increased time until the onset of ischemic symptoms, increased exercise tolerance, and reduced frequency and severity of anginal episodes. Published evidence reports that individuals typically remain symptom-free for several months to two years following a course of ECP treatment.

The course of treatment typically includes 35 one-hour sessions in an office setting. Treatments may be offered once or twice daily and are usually administered five days per week. Components of the treatment include finger plethysmography to measure blood pressure changes, continuous electrocardiogram (EKG) monitoring to trigger inflation and deflation of the cuffs, and pulse oximetry to measure oxygen saturation before and after treatment. Currently, there is one study that shows promising short-term outcomes for repeat ECP treatment. However, the literature is inadequate to provide scientific conclusions regarding the long-term efficacy of repeat ECP treatment.

Although ECP is cleared by the Food and Drug Administration (FDA) 510(k) approval for use in treating a variety of cardiac conditions, including congestive heart failure, stable and unstable angina pectoris, acute myocardial infarction, or cardiogenic shock, the use of ECP to treat conditions other than stable angina pectoris has insufficient evidence to demonstrate its effectiveness. ECP has been investigated for other potential uses such as acute ischemic stroke, erectile dysfunction, retinal artery occlusion, and restless leg syndrome where the effectiveness for these conditions has not been established in the available published peer-reviewed literature.

ECP IN THE TREATMENT OF ANGINA

The pivotal multi-center study of enhanced external counter pulsation (MUST-EECP) (Arora 1999), a randomized, double-blind, sham-controlled trial, showed the clinical benefit of ECP in individuals with chronic stable angina and positive exercise stress tests. In this study, 139 participants with angina pectoris (typical Canadian Cardiovascular Society classes I, II, and III angina) and documented coronary ischemia were equally randomized to 35 hours of active counterpulsation or inactive counterpulsation over a four to seven week period. Outcome measures included exercise duration, exercise time to 1 mm or greater ST-segment depression, average daily anginal attack count, and nitroglycerin usage. Study participants in the active ECP group showed a statistically significant increase in time to exercise induced ST segment depression when compared with sham and baseline, and reported a statistically significant decrease in the frequency of angina episodes when compared with sham and baseline. Exercise duration increased significantly in both groups; however, the increase was greater in the active ECP group. Moreover, a MUST-EECP substudy showed a significant improvement in quality-of-life parameters in individuals assigned to active treatment, which was sustained during a 12 month follow-up period.

ECP IN THE TREATMENT OF HEART FAILURE

In individuals with heart failure and left ventricular dysfunction, the increase in cardiac output and cardiac index by the hemodynamic effects of ECP can also be associated with an acute increase in right atrial mean pressure and pulmonary capillary wedge pressure, and possibly precipitation of an exacerbation of heart failure. Published evidence on the use of ECP to treat heart failure includes the prospective evaluation of enhanced ECP in congestive heart failure (PEECH), a controlled, randomized, single-blinded, parallel-group, multicenter study of 187 individuals with symptomatic but stable heart failure (NYHA functional classes II and III, ischemic and nonischemic etiology) and a left ventricular ejection fraction of 35 percent or less. The medical therapy was optimized in all individuals based on the recommendations of the Heart Failure Society of America (usual care), and then randomized between two treatment groups, usual care or ECP therapy (35 hours over 7 weeks). The results of the PEECH study found statistically improved, but modest, changes in exercise duration and improved functional classification but not in quality of life or peak oxygen uptake (VO2). Thus, this study did not achieve positive results for two primary endpoints. Because individuals were not blinded to therapy, these benefits of ECP therapy may be attributable to a placebo effect. Further research will be necessary to define the impact of ECP in the treatment of heart failure. A subgroup analysis from the PEECH trial for heart failure was also published. It showed that in 41 subjects aged 65 years and older treated with ECP were more likely to meet the exercise duration (35 percent verses 25 percent increased by 60 seconds or greater) and peak VO2 (30 percent versus 11 percent increased by 1.25 or greater mL/kg/min) improvement thresholds compared with 45 subjects undergoing sham treatment. In addition, there was no difference at six months in the NYHA functional class. This post-study analysis must be viewed as a preliminary result. The overall evidence is insufficient to determine whether ECP improves the net health outcome or is as beneficial as any established alternatives in individuals with chronic stable heart failure. Moreover, treatment durability has yet to be addressed with long-term studies. Further high-quality randomized controlled trials (RCTs) are needed to determine whether ECP is a useful treatment for heart failure.

ECP IN THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION

Much has changed in both the definition and the standard of care of an acute myocardial infarction (MI) since the study using ECP therapy was published in 1980 (Joint European Society of Cardiology/American College of Cardiology Committee 2000). Individuals who in 1980 met the criteria for acute MI may not meet the current diagnostic criteria. The standard of care for acute MI has changed since 1980, so it is doubtful that clinicians would apply the same manner of therapy as they did in 1980. Though the 1980 study results may suggest that ECP treatment may have positively impacted morbidity and mortality in acute MI, results of this study are not relevant considering the current standard of care. Thus, the evidence is not adequate to support a health benefit for treatment of acute MI with ECP.

ECP IN THE TREATMENT OF CARDIOGENIC SHOCK

Cardiogenic shock is a life-threatening hemodynamically unstable state. The body of evidence to support the use of ECP for this indication consists of a small case series (Soroff 1974) and two more current small case series (Taguchi 2000), (Michaels 2002) in hemodynamically stable individuals, not in individuals who have a life-threatening hemodynamically unstable state. The results of these studies may suggest that ECP is comparable to intra-aortic balloon pump treatment in certain limited circumstances, but not for the current treatment of cardiogenic shock. A study comparing prevailing therapies in hemodynamically unstable individuals has not been presented as evidence. In summary, the evidence was not adequate to support a health benefit for treatment of cardiogenic shock with ECP.

ECP IN THE TREATMENT OF OTHER CONDITIONS

The use of ECP for other conditions of ischemia has been investigated. Lin et al (2012)evaluated the safety and effectiveness of ECP for acute ischemic stroke in two trials involving 160 individuals.Randomized controlled trials in which ECP (started withinseven days of stroke onset) was compared with sham treatment or no treatment, or ECP plus routine treatment was compared with routine treatment alone, in individuals with acute ischemic stroke. Numbers of death or dependent individuals at the end of at leastthree months follow-up were not reported in either of the included trials. The outcome measure used in the included trials was only the number of participants with improvement of neurological impairment after treatment according to the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) or self-making criteria. External counterpulsation was associated with a significant increase in the number of participants whose neurological impairment improved (risk ratio 1.75, 95 percent confidence interval: 1.37 to 2.23). Onlyone trial reported no adverse events. The authors concluded that the methodological quality of the included studies was poor, reliable conclusions could not be drawn from the present data, and that high-quality and large-scale RCTs are needed.

Published registry studies also report improvements using ECP in erectile function. Erectile function was reported to be improved in a study of 120 men prospectively enrolled from 16 centers. Three of five domains of the International Index of Erectile Function were statistically improved with ECP treatment (erectile function, intercourse satisfaction, overall satisfaction), and the total score improved from 28 to 32, a statistically significant improvement. The noncomparative design of this study makes it difficult to draw conclusions on treatment efficacy. The studies for use of ECP for this indication demonstrates lack of adequate data on clinical outcomes.

Furthermore, additional research into the use of ECP for other conditions such as retinal artery occlusion, and restless leg syndrome are inadequate to draw conclusions about impact on net health outcomes.
References

Arora RR, Chou TM, Jain D, et al. The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol. 1999;33(7):1833-1840.


Brosche TA, Middleton SK, Boogaard RG. Enhanced external counterpulsation. Dimens Crit Care Nurs. 2004;23(5):208-214.

Campeau L. Letter: Grading of angina pectoris. Circulation.1976;54(3):522-523.

Canadian Cardiovascular Society (CCS). Grading of angina pectoris. [CCS Web site]. 1976. Available at: http://www.ccs.ca/images/Guidelines/Guidelines_POS_Library/Ang_Gui_1976.pdfAccessed January 10, 2018.

Centers for Medicare & Medicaid Services (CMS). Medicare National Coverage Determinations Manual. 20.20 External Counterpulsation (ECP) for Severe Angina. [CMS Web site]. 03/20/2006. Available at:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCAId=211&NcaName=Artificial+Hearts&ExpandComments=n&CommentPeriod=0&NCDId=97&ncdver=1&CoverageSelection=National&ncd_id=20.20&ncd_version=2&basket=ncd%2525253A20%2525252E20%2525253A2%2525253AExternal+Counterpulsation+%25252528ECP%25252529+for+Severe+Angin&bc=gAAAABAAIEAAAA%3D%3D&. Accessed January 10, 2018.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System.Publication 100-03: Medicare National Coverage Determinations. Transmittal 50: External counterpulsation therapy. [CMS Web site]. 03/31/2006. Available at: http://www.cms.hhs.gov/Transmittals/downloads/R50NCD.pdf. Accessed January 10, 2018.

Centers for Medicare & Medicaid Services (CMS). CMS Manual System. Publication 100-04: Medicare Claims Processing. Transmittal 898: External counterpulsation (ECP) therapy. [CMS Web site]. 03/31/2006. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R898CP.pdf Accessed January 10, 2018.

Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Database.Decision memo for external counterpulsation (ECP) therapy (CAG-00002R2). [CMS Web site]. 03/20/2006. Available at:
http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=162&ver=21&NcaName=External+Counterpulsation+(ECP)+Therapy+(2nd+Recon)&bc=BEAAAAAAEAAA&&fromdb=true. Accessed January 10, 2018.

Feldman AM, Silver MA, Francis GS, et al. Treating heart failure with enhanced external counterpulsation (EECP): design of the Prospective Evaluation of EECP in Heart Failure (PEECH) trial. J Card Fail. 2005;11(3):240-245.

Fraker TD Jr, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116(23):2762-2772. Epub 2007 Nov 12.

Fraser SG, Adams W. Interventions for acute non-arteritic central retinal artery occlusion. Cochrane Database Syst Rev.2009(1):CD001989.

Han JH, Leung TW, Lam WW, et al. Preliminary findings of external counterpulsation for ischemic stroke patient with large artery occlusive disease. Stroke. 2008;39(4):1340-1343.

Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined - A consensus document of the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. J Am Col Cardiol. 2000;36(3):959-969.

Lawson WE, Barsness G, Michaels AD, et al. IEPR Investigators. Effectiveness of repeat enhanced external counterpulsation for refractory angina in patients failing to complete an initial course of therapy. Cardiology.2007;108(3):170-175.

Lawson WE, Hui JC, Kennard ED, Barsness G, Kelsey SF. IEPR Investigators. Predictors of benefit in angina patients one year after completing enhanced external counterpulsation: initial responders to treatment versus nonresponders. Cardiology. 2005;103(4):201-206.

Lawson WE, Hui JC, Kennard ED, et al. Effect of enhanced external counterpulsation on medically refractory angina patients with erectile dysfunction. Int J Clin Pract. 2007;61(5):757-762.

Lawson WE, Kennard ED, Holubkov R, et al. Benefit and safety of enhanced external counterpulsation in treating coronary artery disease patients with a history of congestive heart failure. Cardiology. 2001;96(2):78-84.

Lin S, Liu M, Wu B, et al. External counterpulsation for acute ischaemic stroke. Cochrane Database Syst Rev.2012;1:CD009264.

Michaels AD, Accad M, Ports TA, et al. Left ventricular systolic unloading and augmentation of intracoronary pressure and Doppler flow during enhanced external counterpulsation. Circulation. 2002;106(10):1237-1242.

Michaels AD, Barsness GW, Soran O, et al. International EECP Patient Registry Investigators. Frequency and efficacy of repeat enhanced external counterpulsation for stable angina pectoris (from the International EECP Patient Registry). Am J Cardiol.2005;95(3):394-397.

Michaels AD, Raisinghani A, Soran O, et al. The effects of enhanced external counterpulsation on myocardial perfusion in patients with stable angina: a multicenter radionuclide study. Am Heart J. 2005;150(5):1066-1073.

Rajaram SS, Shanahan J, Ash C. Enhanced external counter pulsation (EECP) as a novel treatment for restless legs syndrome (RLS): a preliminary test of the vascular neurologic hypothesis for RLS. Sleep Med. 2005;6(2):101-106.

Sangareddi V, Chockalingam A, Gnanavelu G, et al. Canadian Cardiovascular Society classification of effort angina: an angiographic correlation. Coron Artery Dis. 2004;15:111-4.

Soroff HS, Cloutier CT, Birtwell WE, et al. External counterpulsation, management of cardiogenic shock after myocardial infarction. JAMA. 1974;229(11):1441-1450.

Taguchi I, Kenichi O, Oida A, et al. Comparison of hemodynamic effects of enhanced external counterpulsation and intra-aortic balloon pumping in patients with acute myocardial infarction. Am J Cardiol. 2000;86(10):1139-1141.

US Food and Drug Administration (FDA). Cardiomedics, Inc. CardiAssist Counter Pulsation System-Series 4000. 510(k) summary. [FDA Web site]. 03/31/2005. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf5/k050172.pdf. Accessed January 10, 2018.

US Food and Drug Administration (FDA). Enhanced External Counterpulsation MC-2. 510(k) summary. [FDA Web site]. 06/14/2002. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf2/K020857.pdf. Accessed January 10, 2018.

Werner D, Michalk F, Harazny J, et al. Accelerated reperfusion of poorly perfused retinal areas in central retinal artery occlusion and branch retinal artery occlusion after a short treatment with enhanced external counterpulsation. Retina. 2004;24(4):541-547.




Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

I20.1 Angina pectoris with documented spasm

I20.8 Other forms of angina pectoris

I20.9 Angina pectoris, unspecified

I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm

I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris

I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris

I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm

I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris

I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris

I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris

I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris

I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris

I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris

I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris

I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris

I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm

I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris

I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris

I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm

I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris

I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris

I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm

I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris

I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina




HCPCS Level II Code Number(s)

G0166 External counterpulsation, per treatment session


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

07.02.05j

02/15/2018

The policy has been reviewed and reissued to communicate the Company’s continuing position on external counterpulsation (ECP).
Effective 10/05/2017 this policy has been updated to the new policy template format.
Version Effective Date: 09/30/2016
Version Issued Date: 09/30/2016
Version Reissued Date: 02/15/2018

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