C7569 Ptca w/ ivus or oct

Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report

Payer policies and prior authorization for C7569

Payer coverage policies that name C7569

C7569 appears in 3 coverage policies from Aetna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaIntravascular Ultrasound (0382)covered if criteria are metMay 26, 2026payer document
Premera Blue CrossCoronary Angiography for Known or Suspected Coronary Artery Disease in Adults (2.02.507)listed, no stanceAug 11, 2026payer document
Premera Blue CrossPercutaneous Coronary Intervention, Angioplasty, Non-Emergent in Adults (2.02.508)listed, no stanceAug 11, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $3579.24 (asc), effective Oct 1, 2026
  • ND: $3764.30 (physician, facility), 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.