What insurance policy changes affect code R57.0?

There are 11 tracked policy changes affecting code R57.0, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code R57.0?

Payers that have issued tracked updates for code R57.0 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when code R57.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code R57.0. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code R57.0?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

R57.0 Insurance Policy Changes

ICD-10 R57.0 is officially defined as "Cardiogenic shock." code R57.0 is referenced in 11 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code R57.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Mar 19, 2026Medium impact
Ventricular Assist Device (VAD) and Total Artificial Heart (TAH) 7.01.114
Excellus BlueCross BlueShield policy 7.01.114 covers ventricular assist devices (VADs) and total artificial hearts (TAH) for listed indications. FDA-approved VADs are considered medically appropriate as a bridge to transplant for individuals who meet all listed criteria, including approval as a heart transplant candidate by an approved heart transplant center, imminent risk of dying before donor heart procurement, optimal inotropic support, and an intra-aortic balloon pump unless contraindicated. VADs are also considered appropriate as a bridge to recovery and as destination therapy for adults who meet all listed criteria, such as NYHA Class III or IV heart failure, left ventricular ejection fraction of 25% or less, and inotrope dependence or a cardiac index below 2.2 liters/min/m2. Percutaneous VADs are considered medically necessary for listed indications, including high-risk PCI and short-term circulatory support in cardiogenic shock. A TAH is considered medically appropriate as a bridge to transplant, while a TAH as destination therapy is considered investigational.
Aetna · Identified Oct 29, 2026Medium impact
Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)
Aetna's Clinical Policy Bulletin 0801 states that intra-coronary hyperoxemic therapy, also called aqueous oxygen therapy, is experimental, investigational or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient. The policy lists ICD-10 codes as not covered for the indications listed in the policy, and says there are no specific CPT or HCPCS codes for hyperoxemic therapy.
Aetna · Identified Oct 5, 2026Medium impact
Ventricular Assist Devices (CPB 0654, reviewed 2026-09-10)
Aetna Clinical Policy Bulletin 0654 covers ventricular assist devices (VADs) and sets the criteria under which Aetna considers them medically necessary. A VAD is medically necessary as a bridge to transplant when the device has FDA approval for that indication and the member is awaiting heart transplantation. A VAD for destination therapy requires NYHA Class IV end-stage ventricular heart failure, a member who is not a candidate for heart transplant, an LVEF less than 25%, and the medical management and peak oxygen consumption criteria listed in the policy. Percutaneous VADs such as the TandemHeart and Impella are medically necessary for short-term circulatory support in cardiogenic shock and for listed high-risk PCI situations, and VADs are considered experimental, investigational, or unproven for all other indications.
Aetna · Identified Oct 2, 2026Medium impact
Extracorporeal Membrane Oxygenation (ECMO) (CPB 0546, reviewed 2026-08-27)
Aetna considers ECMO medically necessary for neonates who meet all of these criteria: a listed diagnosis (congenital diaphragmatic hernia, hyaline membrane disease, meconium aspiration, persistent fetal circulation, possible cardiac anomaly, refractory neonatal septic shock, respiratory distress syndrome, or uncontrollable air leak), gestational age of at least 34 weeks, birth weight of 2,000 grams or greater, and age less than 10 days (preferably less than 7 days). For children and adults, ECMO and extracorporeal life support are considered medically necessary for listed diagnoses when the risk of death is very high despite optimal conventional therapy, including ARDS, a short-term bridge to heart, liver, lung or heart-lung transplantation or to durable mechanical circulatory support, support following heart surgery to ease the transition from cardiopulmonary bypass to ventilation, non-necrotizing pneumonias, primary graft failure after transplant, pulmonary contusion, refractory pediatric septic shock, smoke inhalation injury, and other reversible causes of respiratory or cardiac failure unresponsive to all other measures. Aetna considers ECMO experimental, investigational, or unproven for all other indications, including acute coronary syndromes, acute massive pulmonary embolism, burns not accompanied by ARDS, cardiogenic shock or smoke inhalation injury, sepsis other than refractory pediatric septic shock, refractory status asthmaticus, tuberculosis, and drug overdose.
Aetna · Identified Sep 30, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)
Aetna considers transcatheter edge-to-edge repair with an FDA-approved device, such as the MitraClip NTR/XTR Clip Delivery System, medically necessary for chronic mitral regurgitation that remains symptomatic despite maximal doses of medical therapy in members with symptomatic severe primary mitral regurgitation who are not considered good candidates for mitral valve surgery, or with symptomatic severe secondary mitral regurgitation who have a left ventricular ejection fraction between 20% and 50%, a left ventricular end-systolic diameter of 70 mm or less, and a pulmonary artery systolic pressure of 70 mmHg or less. Transcatheter mitral valve-in-valve replacement with an FDA-approved device, such as the Edwards-Sapien 3 valve, is considered medically necessary for symptomatic failing surgical bioprosthetic mitral valves when a heart team including a cardiac surgeon judges the member to be at high or greater risk for open surgical therapy, meaning a predicted risk of surgical mortality of 8% or higher at 30 days. Transcatheter edge-to-edge repair with the TriClip device is considered medically necessary for severe tricuspid regurgitation with symptomatic heart failure when all listed criteria are met, while caval valve implantation, transcatheter tricuspid valve replacement, and trans-apical mitral valve repair are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Ventricular Assist Devices (CPB 0654, reviewed 2026-07-17)
Aetna considers an FDA-approved ventricular assist device medically necessary as a bridge to transplant when the device has FDA approval for that indication, and as destination therapy when all of the listed criteria are met: NYHA Class IV end-stage heart failure, not a candidate for heart transplant, failure to respond to optimal medical management for at least 45 of the last 60 days (or balloon pump dependence for 7 days, or IV inotrope dependence for 14 days), LVEF less than 25%, and peak oxygen consumption less than or equal to 14 mL/kg/min. Percutaneous VADs such as the TandemHeart and the Impella are medically necessary for short-term circulatory support in cardiogenic shock and as an adjunct to high-risk PCI in the listed scenarios, and short-term LVADs, RVADs or BiVADs such as the CentriMag are medically necessary for up to 30 days in post-cardiotomy or refractory acute cardiogenic shock when the member is willing and able to be treated with heparin or an appropriate alternative anticoagulant. VADs are considered experimental, investigational or unproven for all other indications, including concomitant mitral valve surgery with LVAD implantation for mitral regurgitation, pVADs during ablation of ventricular tachycardia, implantable aortic counterpulsation ventricular assist systems, and use of mesenchymal precursor cells as adjunctive therapy in VAD recipients.
Aetna · Identified Aug 18, 2026Medium impact
Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2025-12-03)
Aetna considers intra-coronary hyperoxemic therapy, also known as aqueous oxygen therapy or super-oxygenation therapy, experimental, investigational, or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient and effectiveness has not been established. The policy states there are no specific CPT or HCPCS codes for hyperoxemic therapy. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline on the management of acute coronary syndromes does not provide a recommendation for intra-coronary hyperoxemic or supersaturated oxygen therapy.
Aetna · Identified Aug 15, 2026Medium impact
Extracorporeal Membrane Oxygenation (ECMO) (CPB 0546, reviewed 2025-08-21)
Aetna considers ECMO medically necessary for neonates who have one of the listed diagnoses, including congenital diaphragmatic hernia, meconium aspiration, persistent fetal circulation, respiratory distress syndrome, or uncontrollable air leak, when the neonate has a gestational age of at least 34 weeks, a birth weight of 2,000 grams or greater, and an age under 10 days (preferably under 7 days). For children and adults, ECMO and ECLS are considered medically necessary when the risk of death is very high despite optimal conventional therapy, for indications such as ARDS, a short-term bridge to heart, liver, lung or heart-lung transplantation, a short-term bridge to durable mechanical circulatory support, and smoke inhalation injury. Aetna considers ECMO experimental, investigational, or unproven for all other indications, including COVID-19 in persons not meeting the medical necessity criteria, sepsis other than refractory pediatric septic shock, acute coronary syndromes, and tuberculosis.
Aetna · Identified Aug 14, 2026Medium impact
Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)
Balloon valvuloplasty is medically necessary for severe rheumatic mitral stenosis, severe aortic stenosis, and pulmonary valve stenosis when the listed criteria are met. For mitral stenosis with favorable valve anatomy, the criteria include a cumulative echocardiographic score of 8 or less. Balloon dilation for all other indications not listed is experimental, investigational, or unproven, including balloon aortic valvuloplasty used to select transcatheter heart valve size and percutaneous balloon valvuloplasty for bioprosthetic tricuspid valve stenosis.
Aetna · Identified Aug 14, 2026Medium impact
Cryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)
Aetna considers passive cold compression therapy units (such as the Aircast Cryo/Cuff, Polar Care Cub and Polar Care Packs) medically necessary DME to control swelling, edema, hematoma, hemarthrosis and pain, and considers passive hot and cold therapy medically necessary. Cryoanalgesia is considered medically necessary for temporary relief of pain due to chronic refractory trigeminal neuralgia when the selection criteria are met, and for pre-operative, intra-operative and post-operative cryoanalgesia for post-operative pain management related to the Nuss or Ravitch procedure. Active cold units with mechanical pumps, devices that deliver both hot and cold therapy, cryoneurolysis for abdominal pain associated with pancreatic cancer, acute pain, cervicogenic headache, occipital neuralgia, peripheral neuropathic pain, phantom limb pain and post-herpetic neuralgia, pre-operative cryoneurolysis for pain following total knee arthroplasty, prophylactic hypothermia for traumatic brain injury, therapeutic hypothermia for cardiogenic shock or hemorrhagic stroke, intra-brain hypothermia for concussion, submucosal cryolysis, the Cooral intraoral cooling system, and bedside percutaneous cryoneurolysis for acute rib fracture pain are considered experimental, investigational or unproven. Passive cold compression therapy units for all other indications, and intra-operative and post-operative cryoanalgesia for post-thoracotomy pain, post-tonsillectomy pain, post-sternotomy pain and post-mastectomy pain, are also considered experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)
Aetna covers transcatheter mitral valve repair with an FDA-approved device such as the MitraClip for members with chronic mitral regurgitation who remain symptomatic despite maximal doses of medical therapy and meet the listed primary or secondary regurgitation criteria. Transcatheter tricuspid valve repair with the TriClip device is covered only for members with severe tricuspid regurgitation, symptomatic heart failure NYHA class II, III, or IVa, and the other listed criteria, and tricuspid valve repair that does not meet these criteria is considered experimental, investigational, or unproven. Mitral valve-in-valve replacement with the Edwards-Sapien 3 valve is covered for symptomatic failing surgical bioprosthetic mitral valves in members a heart team judges to be at high or greater risk for open surgery.

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Ventricular Assist Device (VAD) and Total Artificial Heart (TAH) 7.01.114

Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)

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

Extracorporeal Membrane Oxygenation (ECMO) (CPB 0546, reviewed 2026-08-27)

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-08-25)

Ventricular Assist Devices (CPB 0654, reviewed 2026-07-17)

Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2025-12-03)

Extracorporeal Membrane Oxygenation (ECMO) (CPB 0546, reviewed 2025-08-21)

Balloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)

Cryoanalgesia and Therapeutic Cold (CPB 0297, reviewed 2026-04-14)

Percutaneous Mitral Valve and Tricuspid Valve Repair (CPB 0880, reviewed 2026-06-05)

What insurance policy changes affect code R57.0?

Which payers have updated policy for code R57.0?

How do I get notified when code R57.0 policy changes?

Why do payers change policies for code R57.0?