CommercialCoverageMedium impact
Ventricular Remodeling Operation (Batista Procedure) and Surgical Ventricular Restoration (Dor Procedure) (CPB 0182, reviewed 2026-03-24)
Aetna·Cardiothoracic Surgery, Cardiology·Surgery
Effective date
Mar 24, 2026
We identified it
Aug 18, 2026
Summary
Aetna's updated policy (CPB 0182, effective 2026-03-24) classifies the Batista procedure (partial left ventriculectomy), Dor procedure (surgical ventricular restoration), and Acorn CorCap Cardiac Support Device as experimental, investigational, or unproven. These procedures are NOT covered by Aetna. Billing teams must deny or obtain prior authorization denials for CPT codes 0643T, 33542, and 33548 when billed with ICD-10 codes I42.0 or I50.1-I50.9.
Action Required
By 2026-03-24: (1) Billing team must update claims processing system to automatically deny or flag for prior authorization review claims for CPT codes 0643T, 33542, and 33548 when linked to ICD-10 codes I42.0 (dilated cardiomyopathy) or I50.1-I50.9 (heart failure). (2) Update billing software to include a hard stop or alert preventing submission of these code combinations without explicit override justification for Aetna commercial plans. (3) Notify cardiothoracic surgery and cardiology providers that these procedures are considered experimental and non-covered; they should consult with Aetna regarding alternative covered procedures (e.g., heart transplantation per CPB 0586, ventricular assist devices per CPB 0654, or cardiac resynchronization therapy per CPB 0610). (4) Prepare denial letter templates citing experimental status per CPB 0182. Failure to implement denials will result in Aetna retroactively denying claims and potential compliance issues.