Atrial Fibrillation: Nonpharmacological Treatments - (0469)

Cigna covers catheter ablation with pulmonary vein isolation (CPT 93656/93657) for symptomatic paroxysmal or persistent AF when antiarrhythmic drugs are ineffective/contraindicated/not tolerated/not preferred, for symptomatic AF with HFrEF (EF ≤40%), in high‑volume endurance athletes, for AF with pulmonary hypertension, and for repeat ablation of recurrent symptomatic AF; percutaneous LAA closure (CPT 33340) is covered for non‑valvular AF with CHA2DS2‑VASc ≥2 and a nonreversible contraindication to long‑term anticoagulation, and surgical Maze (CPT 33258) is covered only when performed with concomitant cardiac surgery — VOM ethanol infusion, standalone surgical LAA exclusion, PDL closure, active esophageal cooling, hybrid Maze without cardiac surgery, and ablation for asymptomatic/other indications are considered not medically necessary or investigational. Coverage requires documentation of the specific indication (symptoms and prior AAD failure/intolerance/contraindication or EF ≤40%/athlete/PH criteria), CHA2DS2‑VASc ≥2 and nonreversible OAC contraindication for LAAO, use of an FDA‑approved device for LAA closure, and appropriate pre/post‑procedural imaging and coding per policy.