Transcatheter Closure of Cardiovascular Defects - (0011)

Cigna covers transcatheter closure only with FDA‑approved devices used per labeling for secundum ASD, PDA, Fontan fenestration, selected muscular/perimembranous VSDs (significant defect, high surgical risk, patient ≥5.2 kg) and PFO closure in patients 18–60 after an ischemic stroke with a negative workup, and excludes other indications (e.g., migraine, decompression illness), ostium primum or sinus venosus ASDs, perventricular VSD closure, and any non‑FDA‑approved device use. Coverage requires documentation of FDA device approval and on‑label use, lesion anatomy and hemodynamic significance (e.g., secundum ASD stretched diameter/adequate rims, Qp:Qs criteria), patient eligibility (age, weight, surgical risk), and appropriate preprocedural imaging, vascular assessment and, for PFO, comprehensive stroke workup and monitoring.

"Transcatheter closure with a U."

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