CommercialCoverageMedium impact
Transcatheter Closure of Patent Ductus Arteriosus
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Cardiothoracic Surgery, Pediatrics·Medical Policy
Effective date
Apr 15, 2025
We identified it
Jun 20, 2026
Summary
BCBS MS clarified their policy on transcatheter closure of Patent Ductus Arteriosus (PDA) by explicitly stating that PFO closure devices (Amplatzer PFO Occluder and Gore Cardioform Septal Occluder) are outside the scope of this policy. Only FDA-approved devices for PDA closure are considered medically necessary, while non-FDA approved devices remain investigational.
Action Required
By April 15, 2025: Billing team must ensure PDA closure procedures using FDA-approved devices (Amplatzer Duct Occluder) are coded appropriately with CPT 93580 or 93799. Verify device approval status before billing. Do not use this policy for PFO closure procedures - these require separate policy review. Update provider documentation to confirm FDA-approved device usage for medical necessity.