Medicare AdvantageCoverageMedium impact
Cardiac Electrophysiological Studies and Cardiac Catheter Ablation - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
Aug 1, 2025
We identified it
Jun 24, 2026
Summary
This policy establishes coverage criteria for cardiac electrophysiological studies (EPS) and cardiac catheter ablation procedures for Medicare Advantage plans, including specific medical necessity requirements for diagnostic EPS, risk stratification, and emerging techniques like pulsed field ablation.
Action Required
Before August 1, 2025: Billing teams must review Medicare Advantage claims for cardiac EPS procedures (CPT 93602-93622) to ensure documentation supports the specific medical necessity criteria outlined in this policy. Update pre-authorization workflows to verify patients meet the established requirements for risk stratification or diagnostic EPS indications. Claims not meeting these criteria may be denied.