CommercialCoverageMedium impact
Transmyocardial and Endovascular Laser Revascularization (CPB 0163, reviewed 2026-03-20)
Aetna·Cardiology, Cardiothoracic Surgery, Critical Care·Medical Policy
Effective date
Mar 20, 2026
We identified it
Aug 18, 2026
Summary
Aetna's updated policy (effective 2026-03-20) clarifies coverage for transmyocardial laser revascularization (TMLR): open chest and thoracoscopic TMLR approaches are covered for medically refractory severe angina when selection criteria are met, but percutaneous TMLR, excimer laser coronary angioplasty, and TMLR combined with cell therapy remain experimental/non-covered. Billing teams must distinguish between covered TMLR procedures (CPT 33140-33141) and non-covered variants to prevent claim denials.
Action Required
By 2026-03-20: Billing team must update system edits and prior authorization workflows to reflect Aetna's TMLR coverage policy. Specifically: (1) CPT 33140-33141 (open chest/thoracoscopic TMLR) require medical necessity documentation and selection criteria verification before claim submission; (2) Deny or route to manual review any claims for CPT 38206, 38232, 38241 (cell therapy codes) when billed with TMLR—these combinations are non-covered; (3) Flag any percutaneous TMLR claims as experimental/non-covered; (4) Deny excimer laser coronary angioplasty claims (no specific CPT code, but monitor for unlisted codes). Providers must document that patients meet refractory angina criteria (severe symptoms despite maximal medical therapy, no viable bypass/angioplasty options per recent coronary angiogram). Update encounter templates and prior auth forms. Failure to implement these edits will result in claim denials and patient balance issues.