CommercialCoverageHigh impact
Maze Procedure (CPB 0225, reviewed 2026-06-29)
Aetna·Cardiothoracic Surgery, Cardiology, General Surgery·Medical Policy
Effective date
Jun 29, 2026
We identified it
Aug 17, 2026
Summary
Aetna's updated Maze procedure policy (CPB 0225, effective 2026-06-29) narrows coverage to only the extensive Maze procedure with cardiopulmonary bypass (CPT 33256) when performed during heart surgery for atrial fibrillation. All minimally invasive and off-pump variants (CPT 33254, 33255, 33258, 33265, 33266) are now classified as experimental/investigational and are not covered. Billing teams must immediately reject claims for non-covered Maze procedure codes.
Action Required
By 2026-06-29: Billing team must update claims processing system to only allow coverage for CPT 33256 (extensive Maze with cardiopulmonary bypass) when billed with an ICD-10 code from I48.0-I48.92 AND when patient is undergoing concurrent heart surgery. Configure system to automatically deny or flag CPT 33254, 33255, 33258, 33265, and 33266 as non-covered (experimental/investigational) under this Aetna policy. Update billing software edit rules and create denial messaging template. Notify cardiac surgery providers and coders of the coverage restriction. Any claims submitted for the four non-covered CPT codes will be denied as experimental procedures not meeting medical necessity criteria.