Medium impact
Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)
Aetna·Effective Jul 17, 2026
Aetna has updated its Balloon Valvuloplasty policy (CPB 0477) effective 2026-07-17, defining medical necessity criteria for three valve types: mitral, aortic, and pulmonary. The policy clearly designates certain procedures as experimental/investigational (balloon aortic valvuloplasty for THV sizing, combined pulmonary valvuloplasty with conal artery occlusion, bioprosthetic tricuspid valve stenosis, and simultaneous TAVR with pulmonary valvuloplasty), which will not be covered. Billing teams must immediately verify procedure indications against specific coverage criteria and reject claims that fall into the experimental category.