Cardioverter-Defibrillator Devices - (0431)

Cigna covers transvenous ICDs, subcutaneous ICDs (S‑ICD), wearable cardioverter‑defibrillators (plan‑dependent), and pediatric home AEDs when patients meet the policy’s specified primary and secondary prevention indications, but considers substernal implantable ICDs (CPT 0571T–0614T) experimental/unproven and not covered and excludes any uses not explicitly listed. Coverage requires documentation that specific criteria are met (e.g., dated LVEF imaging, timing relative to MI/revascularization, EPS results, duration of guideline‑directed medical therapy, diagnosis/genetic evidence, pediatric weight/measurements), S‑ICD is only covered if transvenous criteria are met and the patient does not need bradycardia pacing/CRT/ATP, and claims must use appropriate CPT/HCPCS and diagnosis codes.

"Transvenous ICD — Secondary prevention of sudden cardiac death for ANY of the following: cardiac arrest due to ventricular fibrillation (VF) or hemodynamically unstable sustained ventricular tachyc..."