Cardiac Resynchronization Therapy (CRT) - (0174)
CIGNA-CRT
Cigna covers biventricular CRT (CRT‑P or CRT‑D) and generator/lead replacements as medically necessary for patients with ischemic or nonischemic cardiomyopathy who meet specified criteria (typically LVEF ≤35%, required QRS duration/morphology, rhythm including specified persistent/permanent AF with LBBB and QRS ≥150 ms, and NYHA class) but considers triple‑site (triventricular) pacing experimental/unproven and excludes wireless and leadless CRT and any CRT indications not explicitly listed. Coverage requires ≥3 months of optimal guideline‑directed medical therapy, documented LVEF, ECG QRS duration/morphology, NYHA class (plus specific documentation for AF, anticipated RV pacing, or failed CS/LV lead attempts for conduction system pacing), and use of appropriate procedure/diagnosis codes or claims will be denied.
"Ischemic or nonischemic cardiomyopathy with left ventricular ejection fraction (LVEF) ≤ 35%, sinus rhythm (SR), and any of the following: QRS 120–149 ms, left bundle branch block (LBBB), NYHA Class..."