Left Atrial Appendage and Cardiac Structural Defect Closure - Medicare Advantage

This Medicare Advantage policy covers transcatheter and surgical left atrial appendage (LAA) exclusion/closure and closure of cardiac structural defects (eg, PFO, ASD, septal defects) using devices such as WATCHMAN/FLX, Amplatzer/Amulet, Gore Cardioform, AtriClip and related technologies. It is targeted to patients with non‑valvular atrial fibrillation at risk for cardioembolic stroke and patients evaluated for cryptogenic/ESUS‑related stroke or septal defect closure, but the excerpt contains no explicit coverage criteria, flags insufficient evidence for stand‑alone surgical LAA occlusion and some novel devices (eg, NobleStitch EL), and notes coding/documentation requirements (eg, CPT 33999) and that listed codes do not guarantee coverage.

"Documentation of evaluation by a neurologist and a cardiologist determining the stroke is cryptogenic and due to a presumed paradoxical embolism."