HCPCS Level II › C codes C1761 Cath, trans intra litho/coroCatheter, transluminal intravascular lithotripsy, coronary
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 1 units per day (clinical), rationale: Nature of Service/Procedure Outpatient hospital: max 1 units per day (clinical), rationale: Nature of Service/Procedure Payer policies and prior authorization for C1761 13 of 13 payer prior-auth lists that name C1761 require prior authorization or set conditions: CarePlus Health Plans, Humana, Rocky Mountain Health Plans.
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Payer coverage policies that name C1761 C1761 appears in 4 coverage policies from Aetna, Capital Blue Cross, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (0491) not covered Jul 30, 2026 payer document Aetna Peripheral Atherectomy and Thrombectomy Devices (0295) not covered Apr 16, 2026 payer document Capital Blue Cross Experimental and Investigational Procedures (MP 4.002)Procedure codes: Cardiac listed, no stance Sep 1, 2026 payer document Premera Blue Cross Non-covered Experimental/Investigational ServicesPage | 30 of 38 | ∞ listed, no stance Oct 1, 2026 payer document
Recent prior-auth changes Mar 1, 2025: PA removed, Rocky Mountain Health Plans Mar 1, 2025: PA removed, Rocky Mountain Health Plans Dec 31, 2024: PA removed, Cigna Dec 31, 2024: PA removed, Cigna Medicaid fee-for-service Prior authorization required or conditional in IN.
KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.