MedicaidCoverageHigh impact
Cardiac Devices - MEDICAID - VIRGINIA (Revised)
Humana·VA · Cardiology, Cardiothoracic Surgery, Critical Care +2 more·Medicaid
Effective date
Mar 9, 2026
We identified it
Jun 24, 2026
Summary
This is a new Medicaid policy for Virginia establishing coverage criteria for various cardiac devices including automated external defibrillators, ICDs, wireless PAP sensors, and cardiac monitoring. The policy defines specific eligibility requirements and explicitly excludes coverage for cardiac contractility modulation systems and carotid sinus devices.
Action Required
Before March 9, 2026: Billing team must update Virginia Medicaid billing rules to include new cardiac device coverage criteria. Configure prior authorization requirements for AEDs (E0617) based on specific clinical conditions listed in policy. Update billing system to flag excluded codes (0417T, 0418T, C1824, 0926T, 0927T) as non-covered for Virginia Medicaid. Train staff on documentation requirements for wireless PAP sensors and MCOT eligibility criteria. Claims for excluded cardiac contractility modulation and carotid sinus devices will be denied.