Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure

Aetna covers FDA‑approved biventricular pacemakers (CRT) for CHF in sinus rhythm when either: NYHA III–IV with LVEF ≤35%, QRS ≥150 ms, ≥3 months of maximally tolerated optimal medical therapy and ≥40 days post‑MI; or NYHA II–IV with LVEF ≤35%, left bundle branch block and QRS ≥130 ms with the same medical therapy/post‑MI criteria, and covers CRT‑D devices when these criteria are met and the patient is high risk for sudden cardiac death (e.g., prior cardiac arrest from ventricular tachyarrhythmia). CRT is not medically necessary as adjunctive therapy in patients with an LVAD, for reversible/temporary heart failure or ventricular arrhythmias, or for other indications (e.g., atrial fibrillation, NYHA I), asynchronous/unipolar pacing is contraindicated in specified situations, and wireless left ventricular endocardial pacing is investigational.

"Experimental / investigational: His bundle pacing for cardiac resynchronization therapy."