CommercialCoverageMedium impact
Cardiovascular Ultrafiltration (CPB 0741, reviewed 2025-10-30)
Aetna·Cardiology, Cardiothoracic Surgery, Critical Care +3 more·Medical Policy
Effective date
Oct 30, 2025
We identified it
Aug 15, 2026
Summary
Aetna updated its cardiovascular ultrafiltration policy (CPB 0741) to clarify coverage for peripheral ultrafiltration in acute decompensated heart failure requiring documented diuretic resistance, and modified ultrafiltration in pediatric/neonatal cardiopulmonary bypass. Intermittent peripheral ultrafiltration, peritoneal ultrafiltration, and ultrafiltration for cardio-renal syndrome remain non-covered. Billing teams must ensure claims include proper documentation of diuretic resistance and appropriate ICD-10 codes.
Action Required
By December 30, 2025: Billing team must update system edits to enforce the following rules: (1) CPT 0692T claims for peripheral ultrafiltration require ICD-10 codes I50.20–I50.9 AND clinical documentation of diuretic resistance (dose escalation beyond prior ceiling or approaching maximum daily dose without improvement in diuresis) AND patient must be hospitalized with acute decompensated CHF and dyspnea at rest or minimal activity; (2) CPT 0692T for modified ultrafiltration requires patient age <18 years (pediatric/neonatal) AND cardiopulmonary bypass procedure codes 33010–37790; (3) DENY claims with ICD-10 codes I13.0–I13.2 (cardio-renal syndrome) regardless of CPT code; (4) DENY all claims for intermittent peripheral ultrafiltration or peritoneal ultrafiltration; (5) Add to prior authorization workflow: verify diuretic resistance documentation, confirm inpatient status, and validate age criteria for modified ultrafiltration. Medical records staff must flag cases where diuretic resistance is not documented. Failure to implement will result in claim denials and recoupment requests from Aetna.