Balloon Valvuloplasty

Aetna covers percutaneous balloon valvuloplasty for severe rheumatic mitral stenosis (pregnant patients in 2nd/3rd trimester, favorable valve anatomy with echocardiographic score ≤8, mitral restenosis after surgical commissurotomy, or unfavorable anatomy in poor surgical candidates/refusers) and for severe aortic stenosis only as a bridge to valve replacement in patients at extremely high operative risk; balloon aortic valvuloplasty for THV sizing, percutaneous valvuloplasty for bioprosthetic tricuspid stenosis, and any indications not listed are experimental/investigational and not covered. Coverage requires meeting the policy’s selection/medical-necessity criteria (all listed CPT codes are covered only if criteria are met) and, for mitral stenosis, documented assessment showing a favorable echocardiographic score ≤8 unless an exception applies.

"Appropriate ICD-10 diagnosis codes corresponding to the covered indications (as listed in policy) and CPT procedure code (92986, 92987, 92990) on claims; supporting clinical records as above."