CommercialCoverageMedium impact
Left Atrial Appendage Closure Devices 7.01.92
Excellus BlueCross BlueShield·Cardiology, Cardiothoracic Surgery·Heart & Blood Vessels (Cardiovascular)
Effective date
Sep 18, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new medical policy criteria for Left Atrial Appendage Closure Devices, effective September 18, 2025. The policy defines specific coverage criteria for percutaneous LAA occlusion devices (like WATCHMAN, Amplatzer Amulet) requiring FDA approval, nonvalvular atrial fibrillation, CHA2DS2-VASc score ≥2, and documentation that anticoagulation risks outweigh device implantation risks.
Action Required
Before September 18, 2025: Billing team must review all Left Atrial Appendage Closure Device procedures to ensure documentation includes FDA-approved device confirmation, nonvalvular atrial fibrillation diagnosis, CHA2DS2-VASc score ≥2, anticoagulation recommendation, and physician documentation that long-term anticoagulation risks outweigh device implantation risks. Update prior authorization workflows to verify all five criteria are met before submission. Claims not meeting these criteria will be considered investigational and denied.