Percutaneous left atrial appendage occlusion devices, such as WATCHMAN and Amplatzer Amulet, are considered medically appropriate when the device is FDA approved, the patient has nonvalvular atrial fibrillation with a CHA2DS2-VASc score of 2 or greater, systemic anticoagulation is recommended, and long-term anticoagulation risks outweigh the risks of implantation. Surgical LAA exclusion during cardiac surgery is considered medically appropriate when the patient plans long-term anticoagulation after surgery, the goal is to reduce stroke risk, and the patient has atrial fibrillation with a CHA2DS2-VASc score of 2 or greater or equivalent stroke risk. Surgical LAA exclusion devices, including AtriClip, are considered investigational for stroke prevention in atrial fibrillation as a stand-alone procedure or during a thoracoscopic cardiac procedure, and the current effective date is September 17, 2026.
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01Already effective September 17, 2026: Billing team, before billing percutaneous LAA closure (CPT 33340), confirm the device is FDA approved and the record documents nonvalvular atrial fibrillation with a CHA2DS2-VASc score of 2 or greater.
02Confirm the record shows systemic anticoagulation is recommended and that long-term anticoagulation risks outweigh device implantation risks, decided with an evidence-based decision tool that takes the patient's demonstrated bleeding episodes into account.
03If the patient can take short-term but not long-term oral anticoagulation, confirm this is documented in the medical record and decided through shared decision-making between the patient and the non-implanting physician (primary care physician and/or primary cardiologist).
04For surgical LAA exclusion during cardiac surgery, confirm the patient plans to continue long-term anticoagulation after surgery, the goal is reducing stroke risk, and the patient has atrial fibrillation (ICD-10 codes I48.0 through I48.21 or I48.91).
05CPT 33267 and 33269 are listed as (E/I) experimental/investigational in the code table.
06Codes may not be covered under all circumstances.
Codes mentioned
33267332683326933340I48.91
Original notice
Left Atrial Appendage Closure Devices 7.01.92
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Summaries are AI-assisted. Always confirm against the original payer notice.
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