CommercialCoverageMedium impact
Leadless Cardiac Pacemakers (2.02.32)
Blue Shield of California·CA · Cardiology, Cardiothoracic Surgery, Internal Medicine·Medical Policy
Effective date
Aug 1, 2025
We identified it
Aug 1, 2025
Summary
Blue Shield of California updated their leadless cardiac pacemaker policy, expanding coverage criteria for Micra VR, Aveir, and Micra AV single-chamber systems, and adding new coverage for Aveir DR dual-chamber pacing systems. The policy provides detailed medical necessity criteria for patients with high-grade AV block, bradycardia, or contraindications to conventional pacemakers.
Action Required
Before August 1, 2025: Review patient cases for leadless cardiac pacemaker eligibility using the updated criteria. Ensure documentation includes specific contraindications to conventional pacemakers and meets the detailed medical necessity requirements outlined in the policy. Update prior authorization requests to reference the expanded coverage criteria for single-chamber and new dual-chamber systems.