33999
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- For catheter ablation: documentation of symptomatic atrial fibrillation (paroxysmal or persistent) and that antiarrhythmic drugs have been ineffective, contraindicated, not tolerated or not preferred.
- For catheter ablation in HFrEF: documentation of heart failure with reduced ejection fraction (HFrEF) with ejection fraction ≤ 40%.
- For athlete indication: documentation supporting high-volume endurance athleticism defined as exercise of >45 metabolic equivalent-hours per week.
- For pulmonary hypertension indication: documentation of pulmonary hypertension (PH) with pulmonary vascular disease and atrial fibrillation.
Key Coverage Criteria
- Cardiac catheter ablation with pulmonary vein isolation (Current Procedural Terminology [CPT®] codes 93656, 93657) is considered medically necessary for ANY of the following indications:
- Symptomatic atrial fibrillation (paroxysmal or persistent) AND antiarrhythmic drugs have been ineffective, contraindicated, not tolerated or not preferred
- Symptomatic atrial fibrillation (e.g., palpitations, chest pain, dyspnea) associated with heart failure and reduced ejection fraction (HFrEF) of ≤ 40%
- An athlete* who develops atrial fibrillation with or without symptoms *high-volume endurance athleticism, defined as exercise of >45 metabolic equivalent-hours per week
- Individual with or without symptoms with pulmonary hypertension (PH) with pulmonary vascular disease and atrial fibrillation
- Repeat cardiac catheter ablation is considered medically necessary for an individual with recurrent symptomatic atrial fibrillation (American College of Cardiology Class 1 recommendation).
13 Active Policies
SUR707.026 — Cardiac Restoration and Remodeling Procedures
CIGNA-0469 — Atrial Fibrillation: Nonpharmacological Treatments - (0469)
CIGNA-0431 — Cardioverter-Defibrillator Devices - (0431)
CIGNA-0287 — Cell-Based Therapy for Cardiac and Peripheral Arterial Disease - (0287)
HUMANA-VENTRICULAR-ASSIST-DEVICE-TOTAL-ARTIFICIAL-HEART-MA
Related Codes
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