T82.857A Insurance Policy Changes

ICD-10 T82.857A is officially defined as "Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter." code T82.857A is referenced in 3 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code T82.857A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 29, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)
Aetna considers transcatheter aortic valve implantation (TAVI) medically necessary when criteria are met. Those criteria cover severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and an ejection fraction greater than 20%, and valve-in-valve replacement of a degenerated bioprosthetic aortic valve in patients with a Society of Thoracic Surgeons operative risk score of 8% or greater or a judged 15% or greater risk of mortality from surgical replacement. Percutaneous repair of prosthetic paravalvular leak is also considered medically necessary under specific conditions, while BASILICA, combined TAVI and left atrial appendage occlusion, embolic protection devices, TAVI for ongoing sepsis or endocarditis, and several prognostic tests are listed as experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)
Aetna Clinical Policy Bulletin 0826 covers transcatheter aortic valve implantation (TAVI). Aetna considers TAVI with an FDA-approved valve medically necessary for severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and with an ejection fraction greater than 20%, and for valve-in-valve replacement of a degenerated bioprosthetic aortic valve when the STS operative risk score is 8% or greater or the member is judged to be at 15% or greater risk of mortality for surgical aortic valve replacement. Percutaneous repair of prosthetic paravalvular leak is medically necessary when intractable hemolysis or NYHA class III or IV symptoms, high or prohibitive surgical risk, suitable anatomy and a comprehensive valve center are all met, and BASILICA, combined TAVI and left atrial appendage occlusion, pre-implantation balloon aortic valvuloplasty, embolic protection devices, and TAVI for sepsis, bicuspid aortic stenosis, native aortic valve regurgitation or porcelain aorta are listed as experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Transcatheter Pulmonary Valve Implantation (CPB 0821, reviewed 2026-04-22)
Aetna considers transcatheter pulmonary valve implantation with FDA-approved devices (Harmony Transcatheter Pulmonary Valve System, Melody Transcatheter Pulmonary Valve, and SAPIEN S3 valve) medically necessary for three indications: dysfunctional right ventricular outflow tract (RVOT) conduits whose pulmonary valve is stenotic (mean RVOT gradient 35 mm Hg or greater) or regurgitant (moderate or more severe), where the conduit is full circumferential and 16 mm or greater in diameter; dysfunctional non-conduit, patch-repaired RVOT; and pulmonary insufficiency with progressive right ventricular dilation after failed pulmonary valvulectomy. Aetna considers transcatheter pulmonary valve implantation for other indications, such as valve-in-valve implantation in a degenerated bioprosthetic valve, experimental, investigational, or unproven because its effectiveness for these indications has not been established.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T82.857A?

There are 3 tracked policy changes affecting code T82.857A, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T82.857A?

Payers that have issued tracked updates for code T82.857A include: Aetna.

How do I get notified when code T82.857A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T82.857A. 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 T82.857A?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)

Transcatheter Pulmonary Valve Implantation (CPB 0821, reviewed 2026-04-22)

What insurance policy changes affect code T82.857A?

Which payers have updated policy for code T82.857A?

How do I get notified when code T82.857A policy changes?

Why do payers change policies for code T82.857A?