CPT Codes for Extracranial Vertebral Artery Stenting:
0075T Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel
0076T Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (List separately in addition to code for primary procedure)
Endovascular Therapies for Extracranial Vertebral Artery Disease: An Introduction for Medical Coders & Billers
The vertebral arteries travel along the spine, up the back of the neck, and enter the brain. When one of these arteries is narrowed, blocked, or there is a bulge before it enters the brain, it’s known as extracranial vertebral artery disease. (Extracranial means outside the skull.) Treatment usually involves medication or surgery. Other techniques, performed inside the blood vessels, are continuously being studied. These techniques are known as endovascular therapies, such as placing a tiny tube (stent) inside a blocked artery to allow blood to flow through it. Endovascular therapy for extracranial vertebral artery disease is considered investigational, with ongoing studies to determine its effectiveness compared to standard treatments.
Note: This introduction provides general knowledge and is not policy coverage criteria. The detailed policy below uses specific terminology familiar to medical professionals and is intended for providers (persons or places providing medical care). It offers critical information on service coverage.
Immediate Update: CMS Policy Change for CPT 0075T & 0076T (June 2016)
Medical coders and billers must be aware of a significant policy update from the Centers for Medicare & Medicaid Services (CMS) regarding CPT codes 0075T and 0076T. CMS Transmittal 1672 (CR9631), issued in June 2016, explicitly removed these Category III CPT codes from a list of ‘additional procedure codes’ within the revision history of National Coverage Determinations (NCDs), specifically NCD-110-v5, NCD-123-v1, and NCD-12-v4. This action clarified that these specific ‘T’ codes for endovascular therapies for extracranial vertebral artery disease are not covered under these NCDs and retain their investigational status from a Medicare perspective. Consequently, these procedures are generally not considered reasonable and necessary for Medicare beneficiaries, impacting their coverage and billing.
Current Medicare Coverage Status for Extracranial Vertebral Artery Stenting
As of the latest CMS guidance, endovascular therapy for extracranial vertebral artery disease, including procedures reported with CPT codes 0075T and 0076T, is broadly considered investigational and therefore non-covered by Medicare. This stance is rooted in the lack of sufficient evidence demonstrating its efficacy and safety compared to established treatments, as indicated in various NCDs and reinforced by specific transmittals. Providers should always consult the most recent CMS NCDs, such as **NCD 20.7 (Percutaneous Transluminal Angioplasty)** and any related guidance on investigational services, for the definitive coverage position. Local Coverage Determinations (LCDs) by Medicare Administrative Contractors (MACs) may also provide additional regional specific guidance, though generally, services deemed investigational at the national level remain non-covered.
Service Investigational Status Confirmed
Endovascular therapy, including percutaneous transluminal angioplasty with or without stenting, is considered investigational for the management of extracranial vertebral artery disease. This reinforces the position that these procedures lack sufficient evidence of effectiveness to be considered medically necessary for the general Medicare population. This investigational status is further underscored by CMS Transmittal 1672 (CR9631) from June 2016, which explicitly removed CPT codes 0075T and 0076T from a list of ‘additional procedure codes’ in NCD-related updates, solidifying Medicare’s non-coverage stance.
Note: The extracranial vertebral artery is considered to be segments V1-V3 of the vertebral artery from its origin at the subclavian artery until it crosses the dura mater.
Billing Guidance for Investigational Services: ABN & Modifiers for CPT 0075T & 0076T
Given the investigational and non-covered status of CPT codes 0075T and 0076T for endovascular therapies of extracranial vertebral artery disease, providers must carefully manage billing to ensure compliance and avoid potential issues. When a service is not covered by Medicare because it is deemed investigational, an Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is typically required. An ABN must be issued to the beneficiary before the service is provided, informing them that Medicare is not likely to pay and that they will be financially responsible. For detailed guidance on ABNs, refer to official CMS resources available at cms.gov/Medicare/Medicare-General-Information/BNI/ABN.
When billing for these non-covered investigational services, specific modifiers are applicable:
- -GY Modifier: This modifier indicates that an item or service is statutorily excluded or does not meet the definition of any Medicare benefit. It is used when a service is never covered by Medicare, regardless of medical necessity, such as purely cosmetic procedures or those deemed investigational without specific coverage.
- -GZ Modifier: This modifier signifies that an item or service is expected to be denied as not reasonable and necessary, and an ABN was not issued. Providers should generally avoid using -GZ for investigational services where an ABN should have been obtained. If an ABN was issued, the -GA modifier would typically be used (indicating