33973 Insurance Policy Changes

Ventricular Assist Devices (CPB 0654, reviewed 2026-09-10)

Aetna updated its Ventricular Assist Device (VAD) medical policy (CPB 0654) with clarified coverage criteria for FDA-approved devices across multiple indications including bridge to transplant, destination therapy, refractory electrical storm, percutaneous VADs, pediatric VADs, temporary circulatory support, and the Impella RP System. The policy explicitly identifies which procedures and devices are experimental/investigational (including aortic counter-pulsation systems and concomitant mitral valve surgery with LVAD). Billing teams must verify member eligibility against specific clinical criteria (NYHA Class IV, LVEF <25%, peak VO2 ≤14 mL/kg/min, etc.) before processing claims.