Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), Ch. 1 § 20.2
Extracranial - Intracranial (EC-IC) Arterial Bypass Surgery
20.2 - Extracranial - Intracranial (EC-IC) Arterial Bypass Surgery
(Rev. 1, 10-03-03)
CIM 35-37
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.