Ventricular Assist Devices (VADs), Percutaneous Cardiac Support Systems and Total Artificial Heart - (0054)
CIGNA-VADS
Cigna covers FDA‑approved implantable VADs, specified percutaneous VADs (Impella family, TandemHeart), CentriMag, pediatric VADs (HeartAssist 5, Berlin Heart EXCOR), and the SynCardia temporary total artificial heart as medically necessary for labeled indications (bridge‑to‑transplant, destination therapy in transplant‑ineligible advanced HF, cardiogenic shock, and specified high‑risk PCI use) but deems permanently implantable aortic counterpulsation VADs investigational and percutaneous VADs for unlisted indications (and the SynCardia Freedom Driver outside discharge planning after TAH) not medically necessary. Coverage requires documentation that device‑specific FDA indications/contraindications and the policy’s clinical criteria are met (e.g., NYHA/LVEF/BSA/age thresholds, transplant listing or anticipated transplant, failure/duration of optimal medical therapy or inotrope/IABP dependence, anticoagulation ability, and adherence to device duration/contraindication limits).