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AetnaAll Plans · Coverage · Medical Policy · Cardiology, Cardiothoracic SurgeryMedium impact

Cardiac Devices and Procedures for Occlusion of the Left Atrial Appendage (CPB 0791, reviewed 2026-06-25)

Effective date
Not stated in the notice
Identified
Aug 15, 2026

Summary

Aetna's Clinical Policy Bulletin 0791 covers percutaneous left atrial appendage closure (LAAC) for non-valvular atrial fibrillation only when the device has FDA premarket approval for its FDA-approved indication, the member meets the listed criteria, and LAAC is used as second-line therapy after oral anticoagulants. Surgical left atrial appendage ligation is covered for members with atrial fibrillation and a CHADS2 or CHA2DS2-VASc score of at least 2 who are undergoing open heart surgery and will continue long-term anticoagulation after surgery. Exclusion of the appendage alone during open heart surgery, the AtriClip device, and percutaneous closure with any device other than the Amplatzer Amulet and Watchman are listed as experimental, investigational, or unproven.

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What to do

Action · 8 steps
01Billing team: Before LAAC is performed, confirm the chart documents a CHADS2 or CHA2DS2-VASc score of at least 2, and a formal shared decision making interaction with an independent non-interventional physician using an evidence-based decision tool on oral anticoagulation, recorded in the medical record.
02Confirm the chart documents that the member is suitable for short-term dual antiplatelet therapy or warfarin for 45 days and long-term aspirin, but cannot take long-term oral anticoagulation because of thromboembolism, a major bleed, or another absolute contraindication.
03Confirm the procedure uses the Amplatzer Amulet or Watchman device in a hospital with an established structural heart disease and/or electrophysiology program, and that the member is under the care of a multidisciplinary team before and after the procedure.
04Confirm the operator has manufacturer-prescribed training, has performed at least 25 interventional cardiac procedures involving transeptal puncture through an intact septum, and continues to perform at least 25 such procedures, at least 12 of them LAAC, over two years.
05Confirm the member is enrolled in a prospective, national, audited registry that the multidisciplinary team and hospital participate in.
06Aetna considers percutaneous LAA closure an outpatient procedure.
07Aetna will not reimburse a transesophageal echocardiogram for the same provider who places the Watchman.
08For surgical LAA ligation during open heart surgery, document atrial fibrillation, a CHADS2 or CHA2DS2-VASc score of at least 2, and continued long-term anticoagulation after surgery.

Codes mentioned

3326733268332693334093318C1760C1817C2628I48.0I48.11I48.19I48.20I48.21I48.91I63.30I63.9I66.01I66.9

Original notice

Cardiac Devices and Procedures for Occlusion of the Left Atrial Appendage (CPB 0791, reviewed 2026-06-25)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesCardiologyCardiothoracic SurgeryCode 33267Code 33268Code 33269Code 33340Code 93318Code C1760Code C1817Code C2628Code I48.0Code I48.11Code I48.19Code I48.20Code I48.21Code I48.91Code I63.30Code I63.9Code I66.01Code I66.9

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