Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Cardiology, Cardiothoracic SurgeryMedium impact
Transcatheter Aortic Valve Implantation for Aortic Stenosis
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Transcatheter aortic valve replacement with an FDA-approved transcatheter heart valve system may be considered medically necessary for individuals with native valve aortic stenosis who have severe aortic stenosis with a calcified aortic valve, New York Heart Association Class II, III or IV heart failure symptoms, and no unicuspid or bicuspid aortic valves. Valve-in-valve replacement of a failed surgical bioprosthetic aortic valve may be considered medically necessary when the individual meets the policy's surgical risk criteria documented by at least 2 cardiovascular specialists, and use of a cerebral embolic protection device (e.g., Sentinel) during these procedures is considered investigational. The 08/13/2025 update changed the policy description regarding devices, and the policy statements are unchanged.
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01Billing team: Before billing transcatheter aortic valve replacement (CPT 33361 through 33369) for native valve aortic stenosis, confirm the individual has severe aortic stenosis with a calcified aortic valve, NYHA Class II, III or IV heart failure symptoms, and no unicuspid or bicuspid aortic valves.
02For valve-in-valve procedures, confirm the failed surgical bioprosthetic valve and the surgical risk documentation from at least 2 cardiovascular specialists, including a cardiac surgeon, as the policy requires.
03The listed covered codes are ONLY medically necessary if the procedure is performed according to the policy section.
04Transcatheter aortic valve replacement for all other indications, and cerebral embolic protection device placement (CPT 33370), are considered investigational.
Summaries are AI-assisted. Always confirm against the original payer notice.
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