Reimbursement for carotid stenting: unique challenges for medical centers and physicians

Carotid artery stenting has been identified as an important therapeutic option for patients with atherosclerotic occlusive disease of the extracranial carotid artery. While the preferred application of this technology remains an area of active clinical investigation and its optimal role may continue to evolve, a preponderance of opinion supports its present application in carefully selected patients. Enabling the introduction of this technology into the broader patient community mandated a consensus between a large number of specialty societies and the Centers for Medicare and Medicaid Services to define both currently acceptable procedures to be performed and appropriate clinical criteria for its suitable application. This report reviews the collaborative process, which evolved to achieve this consensus and the current guidelines for procedural coding, facility accreditation, and reimbursement for carotid artery stenting. Related requirements for Medicare coverage of patients in clinical trials and registries are also discussed.