Cardiac Stents

There are two general types of stent: bare metal stents (BMS) and drug eluting stents (DES). DES are essentially BMS that have been coated with a polymer containing an anti-proliferative drug, which inhibits vascular smooth cell proliferation and migration to prevent the neo-intimal hyperplasia. For patients being treated for coronary artery disease (CAD), consideration of revascularization with cardiac stents is based on the clinical presentation, the severity of the angina, the extent of ischemia and presence or absence of other prognostic factors. For injured workers, the procedure may be covered only for care of a condition accepted on or related to the claim.

Coverage decision: Covered with Conditions (Effective August 1, 2016)

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund): Request Utilization Review provided by Qualis

For self-insured: Contact the employer or its third party administrator

 

Regulatory authority and related information

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