Ventricular Assist Devices

Aetna covers FDA‑approved VADs as a bridge to transplant or as destination therapy (NYHA Class IV, LVEF <25%, failure of optimal medical management for ≥45 of the last 60 days or balloon‑pump dependent 7 days or IV inotrope dependent 14 days, and peak VO2 ≤14 ml/kg/min — exercise testing may be waived), FDA‑approved percutaneous VADs (e.g., TandemHeart, Impella) for short‑term circulatory support in cardiogenic shock or as an adjunct to high‑risk PCI (unprotected left main/last‑remaining‑conduit with EF <35% or three‑vessel disease with EF <30%), and FDA‑approved pediatric VADs for documented end‑stage left ventricular failure when an age‑ and size‑appropriate device is used as a bridge to transplant. All other indications (including other pediatric uses, RVADs, and pVAD uses not listed) are considered experimental/investigational, and the Impella RP is limited to acute right‑heart failure/decompensation for up to 14 days in patients with BSA ≥1.5 m2 following LVAD implantation, MI, heart transplant, or open‑heart surgery.