High impact
Cardiac Catheter Ablation (CPB 0165, reviewed 2026-08-25)
Aetna·Identified Oct 2, 2026
Aetna's Cardiac Catheter Ablation policy (CPB 0165) was reviewed on August 25, 2026, establishing comprehensive medical necessity criteria for ablation procedures across multiple arrhythmia types including atrial fibrillation, ventricular tachycardia, and accessory pathway disorders. The policy clarifies that pulsed field ablation is an acceptable alternative to radiofrequency ablation, requires electrophysiology studies only if none performed in prior 3 months, and designates specific procedures as experimental/investigational. Billing teams must ensure claims align with the detailed inclusion criteria and avoid billing for non-covered experimental procedures.