What insurance policy changes affect code T86.298?

There are 4 tracked policy changes affecting code T86.298, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T86.298?

Payers that have issued tracked updates for code T86.298 include: Aetna.

How do I get notified when code T86.298 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T86.298. 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 T86.298?

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

T86.298 Insurance Policy Changes

ICD-10 T86.298 is officially defined as "Other complications of heart transplant." code T86.298 is referenced in 4 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 T86.298 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 4, 2026Medium impact
Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Examples of qualifying conditions include COPD with severe heart failure, cystic fibrosis with severe heart failure, congenital heart disease with pulmonary hypertension that is not amenable to lung transplantation and repair by standard cardiac surgery, and Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function.
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 17, 2026Medium impact
Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function, and every attempt should be made to preserve the heart. The member must meet the transplanting institution's selection criteria, and in the absence of those criteria, Aetna's listed criteria apply.

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

Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)

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

Heart-Lung Transplantation (CPB 0597, reviewed 2025-12-02)

What insurance policy changes affect code T86.298?

Which payers have updated policy for code T86.298?

How do I get notified when code T86.298 policy changes?

Why do payers change policies for code T86.298?