C2624, Implantable wireless pulmonary artery pressure sensor with delivery catheter,
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Documentation Required
- For home blood pressure monitor coverage: 'the blood pressure cuff is prescribed by a physician.'
- CDC statement: 'patients should only use monitors that have been properly validated and tested for accuracy, passing at least 1 accepted standardized international testing protocol. The 3 widely accepted validation protocols are from the Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society (BHS), and the European Hypertension Society (EHS). The CDC noted that not all available home BP monitors have passed these validation tests.' (implies documentation of device validation may be required)
- For investigational devices (AngelMed, Chronicle IHM): documentation of investigational status / IDE or trial enrollment is implied by the text: 'The Chronicle IHM has an investigational device exemption in the United States, which allows use of the device in clinical trials.'
Key Coverage Criteria
- 93280 dual lead pacemaker system
- 93281 multiple lead pacemaker system
- Z99.2 Dependence on renal dialysis
- Other CPT codes related to the CPB (listed as related items): 90935 - 90937 Hemodialysis
- Aetna considers self-contained pacemaker monitors medically necessary for members with cardiac pacemakers.
- Audible/visible signal pacemaker monitors -- these devices produce an audible and visible signal that indicates the pacemaker rate.
11 Active Policies
CIGNA-0574, Cardiac Omnibus Codes
ANTHEM-MED.00115, MED.00115 Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management
AETNA-CPB-0548, Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors
AMBETTER-CP.MP.160, Implantable Wireless Pulmonary Artery Pressure Monitoring
BCBSIL-MED202.058
Related Codes
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