Publication Number

100-4

Manual Section Number

20.2

Version Number

1

Effective Date of this Version

3/27/1991

Benefit Category

Inpatient Hospital Services
Physicians' Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Indications and Limitations of Coverage

Extracranial-Intracranial (EC-IC) arterial bypass surgery is not a covered procedure when it is performed as a treatment for ischemic cerebrovascular disease of the carotid or middle cerebral arteries, which includes the treatment or prevention of strokes. The premise that this procedure which bypasses narrowed arterial segments improves the blood supply to the brain and reduces the risk of having a stroke has not been demonstrated to be any more effective than no surgical intervention. Accordingly, EC-IC arterial bypass surgery is not considered reasonable and necessary within the meaning of §1862(a)(1) of the Act when it is performed as a treatment for ischemic cerebrovascular disease of the carotid or middle cerebral arteries.

Transmittal Number

47

Revision History

06/1991 - Renamed to reflect current terminology for procedure and revised to provide that Medicare coverage no longer allowed when EC-IC surgery performed to treat ischemic cerebrovascular disease of carotid or middle cerebral arteries. Effective date 03/27/1991. (TN 47)

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