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In the 1980s, excimer laser angioplasty was developed as an alternative method of percutaneous angioplasty, with the objective of reducing the high rate of restenosis associated with other angioplasty or stenting techniques. Excimer laser coronary angioplasty (ELCA) is a procedure that utilizes an intravascular catheter system to deliver high-energy laser light to atherosclerotic lesions that are causing stenosis or occlusion of native coronary arteries, vein grafts placed at previous coronary artery bypass surgery, or stainless steel intracoronary stents, while producing relatively little thermal damage to the vessel wall. ELCA is usually performed in combination with balloon angioplasty and is intended as a minimally invasive alternative to open surgical revascularization for patients with atherosclerotic coronary lesions.
Excimer laser coronary angioplasty (ELCA) for the treatment of atherosclerotic lesions that are causing stenosis or occlusion of native coronary arteries, vein grafts placed at coronary artery bypass surgery, or stainless steel intracoronary stents is considered investigational.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY8/2002: Approved by Medical Policy Advisory Committee (MPAC)
12/19/2003: Code Reference section completed
10/16/2006: Policy reviewed, no changes
08/25/2015: Code Reference section updated for ICD-10. Removed ICD-9 procedure code 39.59 from the Code Reference section. Added ICD-9 procedure code 36.09.
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.