Does C1817 require prior authorization?

Yes, C1817 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

`C1817`, Septal defect implant system, intracardiac

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

For PDA: clinical documentation supporting device selection (policy references use of Amplatzer ductal occluder in moderate-to-large PDAs and prior trials showing use in pediatric population).
General documentation implied by policy: pre-procedure and follow-up echocardiography (TEE/TTE) and clinical follow-up notes (policy cites necessity of pre-procedure and post-procedure echo and follow-up schedules in clinical studies).
No explicit documentation requirements (e.g., precise CMS/Medicare medical necessity statement or required ICD-10 documentation) are stated in the provided text.
Echocardiographic morphology documentation for ASDs: 'echocardiographic morphology of the ASD with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim.'

93582 Percutaneous transcatheter closure of patent ductus arteriosus
Aspiration thrombectomy with the AngioVac system for percutaneous removal of thrombus in the venous system.
Right-sided transcatheter vacuum-assisted mass extraction (TVME) including: right-sided heart chamber thrombi, right-sided infective endocarditis (RSIE) vegetations, venous thrombus, lead-related infection/thrombus aspiration, and right-sided cardiac mass evacuation.
AngioVac-assisted vegetation debulking (AVD) for right-sided infective endocarditis (RSIE) — described in systematic reviews and case series with reported procedural and clinical success.
Percutaneous vacuum-assisted debulking of large vegetations as an adjunct to lead extraction.
Transcatheter vacuum-assisted left-sided mass extraction (left-sided TVME) — reported in small case series and single-center reports (noted as limited/experimental/off-label use in the text).

HUMANA-LEFT-ATRIAL-APPENDAGE-AND-CARDIAC-STRUCTURAL-DEFECT-CLOSURE-MA, Left Atrial Appendage and Cardiac Structural Defect Closure

AETNA-CPB-0292, Catheter-Directed Cardiac Procedures

BCBSIL-SUR707.024, Closure Devices for Patent Foramen Ovale and Atrial Septal Defects

BCBSMT-SUR707.024, Closure Devices for Patent Foramen Ovale and Atrial Septal Defects

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