93653
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
14.63
Facility
$711.44
Non-Facility
$711.44
Documentation Required
- Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage.
- Refer to the protocol titled Medical Records Documentation Used for Reviews.
- When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.
- Before using this policy, please check the member specific benefit plan document and any applicable federal or state mandates.
Key Coverage Criteria
- Catheter ablation for atrial fibrillation is proven and medically necessary in certain circumstances.
- For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures, Electrophysiology (EP) Testing +/- Radiofrequency Ablation (RFA) or Cryothermal Ablation, Cardiac.
- This Medical Policy applies to UnitedHealthcare Commercial benefit plans.
- This Medical Policy applies to Individual Exchange benefit plans.
- Note: This policy does not apply to members ages < 18 years or to arrhythmias other than atrial fibrillation.
- During excision of left atrial mass;
8 Active Policies
CARELON-transcatheter-ablation-for-supraventricular-and-ventricular-arrhythmias-2024-07-01 — Transcatheter Ablation for Supraventricular and Ventricular Arrhythmias
CARELON-transcatheter-ablation-for-management-of-atrial-fibrillation-2024-07-01-r0125 — Transcatheter Ablation for Management of Atrial Fibrillation
UMR-POL-UMR-catheter-ablation-atrial-fibrillation — Catheter Ablation for Atrial Fibrillation
SUREST-POL-SUREST-catheter-ablation-atrial-fibrillation — Catheter Ablation for Atrial Fibrillation
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.