External Counterpulsation (ECP) Therapy for Severe Angina

This policy covers external counterpulsation (ECP), including enhanced ECP, for severe/refractory stable angina to augment diastolic pressure and improve myocardial perfusion, increase time to ischemia and exercise tolerance. Coverage is limited to patients with disabling angina (e.g., NYHA Class III/IV or equivalent) with specialist documentation that PTCA/CABG is not feasible or poses excessive risk; it is not covered if the patient is readily amenable to surgical intervention, generally requires a full course of ~35 one‑hour treatments under direct physician supervision, must use FDA 510(k)-cleared devices, and is investigational for other cardiac indications and subject to member benefit/CMS limitations.

"Disabling angina defined as New York Heart Association (NYHA) Class III or IV, Canadian Cardiovascular Society (CCS) classification, or equivalent."

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