Cardiac Electrophysiological (EP) Studies - (0532)

Cigna covers invasive cardiac electrophysiological (EP) studies for specified diagnostic and risk‑stratification indications (e.g., primary/secondary SCD evaluation, ventricular and supraventricular arrhythmias, syncope of suspected arrhythmic etiology, adult congenital heart disease, cardiac sarcoidosis, ARVC, and Brugada syndrome) but considers EP studies not medically necessary for hypertrophic cardiomyopathy risk stratification, solely inducing VA in patients who already meet ICD criteria, and for inherited arrhythmia syndromes such as long QT, CPVT, short QT, or early repolarization. Key requirements include thorough documentation (history/physical, baseline and arrhythmia ECGs), appropriate noninvasive testing (echocardiography, up to 4‑week event monitoring, exercise testing, cardiac imaging/catheterization as indicated), discontinuation of AV‑nodal blocking/class I/III drugs when appropriate, adherence to absolute procedural contraindications (e.g., unstable angina, bacteremia, acute decompensated HF, major bleeding diathesis, acute DVT if femoral access planned), and correct diagnosis/procedure coding for claims.