CommercialCoverageMedium impact
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices - (Effective Date - 2026-06-15) 7.01.58
Excellus BlueCross BlueShield·Cardiology, Cardiothoracic Surgery, Internal Medicine +1 more·Heart & Blood Vessels (Cardiovascular)
Effective date
Jun 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their pacemaker and cardiac resynchronization therapy (CRT) device policy effective June 15, 2026. The policy establishes detailed medical necessity criteria for permanent pacemaker implantation across various cardiac conditions including sinus node dysfunction, atrioventricular blocks, conduction disorders, and post-procedural indications.
Action Required
Before June 15, 2026: Clinical documentation team must ensure all pacemaker implantation cases meet the specific medical necessity criteria outlined in policy 7.01.58. Update pre-authorization workflows to verify patients have documented symptoms, appropriate heart rate thresholds, and qualifying cardiac conditions. Train providers on new documentation requirements for sinus node dysfunction, AV blocks, and conduction disorders to prevent claim denials.