Cardioverter-Defibrillators

Aetna covers FDA‑approved implantable cardioverter‑defibrillators (thoracotomy and non‑thoracotomy) for patients with prior or inducible ventricular fibrillation, documented syncopal or hypotensive ventricular tachycardia not due to acute MI or remediable causes, VT/VF cardiac arrest without an inducible arrhythmia, and spontaneous sustained VT (>30 seconds) in those with structural heart disease or normal/near‑normal ventricular function. ICDs are experimental/investigational for other indications (including subcutaneous ICDs beyond the listed indications, ICDs with hemodynamic monitoring, use in LVAD patients, NT‑proBNP for prognostic assessment, and wearable/non‑wearable defibrillators post‑CABG/PTCA when indications are not met), are not medically necessary if severe comorbidities limit life expectancy, and subcutaneous ICDs are not indicated for symptomatic bradycardia, incessant VT, or frequently recurring VT reliably terminated with anti‑tachycardia pacing.