Selected Aortic Valve Procedures: Ross Pulmonary Autograft and Aortic Valve-Sparing Re-implantation

Aetna covers the Ross pulmonary autograft only for aortic valve replacement due to congenital anomalies or aortic valve disease (including aortic incompetence/endocarditis/rheumatic disease), aortic stenosis, and congenital lesions, and considers minimally invasive aortic valve approaches acceptable; aortic valve‑sparing re‑implantation is covered only for secondary aortic regurgitation from aortic root dilatation (e.g., Marfan), type A acute aortic dissection, and for treatment of aortic root ectasia/ascending aortic dissection and aneurysms. Ross procedures are investigational and not covered for all other indications (including use in middle‑aged/older adults or in bicuspid valve disease when suitable alternatives exist), and the Decellularized Matrix P bioprosthesis for pulmonary valve replacement in Ross procedures is investigational/not covered.

"Referral/center expertise: documentation that patient was referred to or treated at an experienced center with a program dedicated to the Ross procedure when applicable (policy notes that patients ..."