Maze Procedure

Aetna covers the Maze procedure performed with cardiopulmonary bypass on a beating heart for atrial fibrillation/flutter only when there is documented intolerance to drug therapy, persistent hemodynamic consequences despite adequate medical management, high thromboembolic risk (prior embolus after excluding other sources or long‑standing AF with mitral valve disease undergoing open mitral repair), or when done concomitantly with septal myectomy for HOCM with refractory AF. Off‑pump, minimally invasive, or hybrid Maze procedures (including the Convergent/TOPS approaches) are considered experimental/investigational and not covered—CPTs 33255, +33258, 33265, 33266 are explicitly excluded—and routine postoperative surveillance tests are not routinely medically necessary unless clinically indicated.

"Maze procedure, performed with cardiopulmonary bypass on a beating heart, is medically necessary for members with atrial fibrillation or atrial flutter when any of the following criteria is met:"