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Leadless Cardiac Pacemakers
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
The BCBSMS leadless cardiac pacemaker policy was updated on 09/01/2025. CPT codes 0795T through 0804T for dual-chamber leadless pacemaker systems moved from investigational to medically necessary, and the Aveir DR dual-chamber pacing system is considered medically necessary when the listed conditions are met. The single-chamber criteria were also revised, replacing 'Presence of a bioprosthetic tricuspid valve' with 'Presence of or at risk of tricuspid valve replacement or severe tricuspid valve regurgitation.'
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What to do
Action · 8 steps
01Bill the leadless pacemaker codes listed in the Code Reference (33274, 33275, and 0795T through 0804T) only when the procedure is performed according to the policy.
02For a single-chamber Micra VR or Aveir system, document high-grade AV block with atrial fibrillation or significant bradycardia (normal sinus rhythm with rare episodes of 2 or 3 AV block or sinus arrest, chronic atrial fibrillation, or severe physical disability), and a significant contraindication to conventional single-chamber ventricular pacemaker leads, such as a history of or high risk for CIED infection, limited access for transvenous pacing, or presence of or risk of tricuspid valve replacement or severe tricuspid valve regurgitation.
03For the Micra AV system, the indication may also be an indication for VDD pacing where the individual may benefit from maintained AV synchronous ventricular pacing.
04Micra and Aveir single-chamber systems and the Aveir DR system are also considered medically necessary for individuals who are medically eligible for a conventional pacing system but have lifestyle or anatomic reasons directing use of leadless pacing.
05For the Aveir DR dual-chamber system, document one of the following: sick sinus syndrome, chronic symptomatic 2 or 3 AV block, recurrent Adams-Stokes syndrome, or symptomatic bilateral bundle branch block when tachyarrhythmia and other causes have been ruled out, plus a significant contraindication to conventional dual-chamber leads (the same contraindication categories listed above).
06The Micra and Aveir single-chamber systems and the Aveir DR dual-chamber system are considered investigational in all other situations where these criteria are not met.
07BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be medically necessary.
08For Federal Employee Program members, the policy notes that FEP may dictate that FDA-approved devices are not considered investigational and may be assessed only on the basis of medical necessity.
Codes mentioned
3327433275
Original notice
Leadless Cardiac Pacemakers
bcbsms.com · Always check the source before changing claims.