SURG.00032 Patent Foramen Ovale and Left Atrial Appendage Closure Devices

Policy SURG.00032 addresses transcatheter patent foramen ovale (PFO) closure and left atrial appendage (LAA) closure devices. PFO closure with an FDA‑approved device is medically necessary to prevent recurrent stroke after cryptogenic stroke when either: (1) age ≤60 with an atrial septal aneurysm or a large interatrial shunt, or (2) any age with failure of or contraindication to conventional drug therapy (e.g., warfarin). Not covered: PFO closure for stroke prevention when these criteria are not met and for other indications (e.g., migraine, decompression sickness, platypnea‑orthodeoxia) is investigational/not medically necessary; transcatheter LAA closure is not medically necessary when criteria are unmet, and surgical LAA device closure is investigational/not medically necessary for all indications.

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