Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · Cardiology, Cardiothoracic SurgeryMedium impact
Baroreflex Stimulation Devices (8.01.57)
Effective date
Nov 1, 2026
Identified
Nov 1, 2025
Summary
Blue Shield of California's medical policy 8.01.57 on baroreflex stimulation devices has an effective date of November 1, 2026, and its policy statement has not changed. Baroreflex stimulation therapy with an FDA-approved device is investigational for individuals with heart failure despite the use of maximally tolerated guideline-directed medical and device therapy, and for all other indications. The FDA-approved Barostim Neo system is indicated for patients with NYHA Class III or Class II heart failure (with a recent history of Class III) who remain symptomatic despite guideline-directed therapy, have an LVEF of 35% or less and NT-proBNP below 1600 pg/ml, and are not indicated for cardiac resynchronization therapy.
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01Already effective November 1, 2026: Billing team: check the member's contract benefits in effect at the time of service, since those contract terms control coverage under this policy.
02Baroreflex stimulation therapy is investigational under this policy for heart failure despite maximally tolerated guideline-directed medical and device therapy and for all other indications.
03Use the Coding section of the policy: codes 64654, 64655, 64656, 64657, 64658, 64659, 93145, 93146 and HCPCS C1825 are listed as effective 1/1/2026, and codes 0266T through 0273T were deleted effective 1/1/2026.
04For questions about whether this policy applies, contact the Prior Authorization Department at (800) 541-6652.
05Documentation for clinical review: no records are required under this policy.
Codes mentioned
6465464655646566465764658646599314593146C1825
Original notice
Baroreflex Stimulation Devices (8.01.57)
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