C1886 — Catheter, extravascular tissue ablation, any modality (insertable)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Note on Documentation Requirements: Physicians are reminded to bill the findings of the diagnostic test as the primary indication rather than the referring physician’s diagnosis, as indicated by Medicare’s Diagnostic Imaging Billing guidelines.
- These guidelines are available in the Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures (revised November 2016).
- Policy table headings and entries indicate that CPT and ICD-10 codes are "covered if selection criteria are met" — documentation should support that selection criteria/medical necessity are met (implied requirement).
- No discrete 'Documentation Requirements' section is provided in this excerpt; however the policy implies that clinical documentation must support the specific selection criteria attached to each covered indication (examples below).
Key Coverage Criteria
- During excision of left atrial mass;
- Evaluation of angina;
- Evaluation of aortic diseases;
- Evaluation of aortocoronary bypass grafts;
- Evaluation of atrial fibrillation/flutter;
- ICD-10 I05.0 - I05.9: Diseases of mitral valve
4 Active Policies
AETNA-CPB-0100 — Cryoablation
AETNA-CPB-0008 — Color-Flow Doppler Echocardiography in Adults
AETNA-CPB-0592 — Intranasal Radiofrequency Ablation
AETNA-CPB-0754 — Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments
Related Codes
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