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Conversion of Anti-Coagulants to Heparin Before and After Elective Surgery (CPB 0200, reviewed 2026-03-25)
Effective date
Not stated in the notice
Identified
Aug 12, 2026
Summary
Aetna considers continuous intravenous heparin infusion medically necessary for members taking apixaban, dabigatran, edoxaban, rivaroxaban or warfarin who require maintenance of anticoagulation before and after diagnostic or therapeutic procedures. For most members, pre-procedure weaning of the oral anticoagulant may be safely accomplished on an outpatient basis. When circumstances arise that might compromise the member's state of anticoagulation such that thrombotic complications may occur, up to 3 inpatient pre-procedure days may be considered medically necessary.
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What to do
Action · 4 steps
01Billing team: before billing continuous intravenous heparin infusion (HCPCS J1642, J1643, J1644), confirm the member takes apixaban, dabigatran, edoxaban, rivaroxaban or warfarin and requires maintenance of anticoagulation before and after a diagnostic or therapeutic procedure.
02Pre-procedure weaning of the oral anticoagulant may be done on an outpatient basis for most members.
03Up to 3 inpatient pre-procedure days may be considered medically necessary only when circumstances arise that might compromise anticoagulation such that thrombotic complications may occur.
04Home continuous anticoagulant infusion therapy (HCPCS S9336, per diem) and the long-term anticoagulant use diagnosis (ICD-10 Z79.01) are covered if the selection criteria are met.
Codes mentioned
J1642J1643J1644S9336Z79.01
Original notice
Conversion of Anti-Coagulants to Heparin Before and After Elective Surgery (CPB 0200, reviewed 2026-03-25)
aetna.com · Always check the source before changing claims.
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