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AetnaCommercial · Coverage · Surgery · Cardiology, Cardiothoracic SurgeryMedium impact

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)

Effective date
Not stated in the notice
Identified
Oct 29, 2026

Summary

Aetna considers transcatheter aortic valve implantation (TAVI) medically necessary when criteria are met. Those criteria cover severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency and an ejection fraction greater than 20%, and valve-in-valve replacement of a degenerated bioprosthetic aortic valve in patients with a Society of Thoracic Surgeons operative risk score of 8% or greater or a judged 15% or greater risk of mortality from surgical replacement. Percutaneous repair of prosthetic paravalvular leak is also considered medically necessary under specific conditions, while BASILICA, combined TAVI and left atrial appendage occlusion, embolic protection devices, TAVI for ongoing sepsis or endocarditis, and several prognostic tests are listed as experimental, investigational or unproven.

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What to do

Action · 5 steps
01Billing team: Bill TAVI codes 33361 through 33369 only for members who meet the selection criteria in this policy, using an FDA-approved valve such as the Edwards Sapien 3, Edwards Sapien XT, Edwards Sapien transcatheter heart valve, or Medtronic CoreValve System.
02For native valve stenosis, the criteria are severe symptomatic calcified native aortic valve stenosis without severe aortic insufficiency, an ejection fraction greater than 20%, and co-morbidities that would not preclude the expected benefit from correcting the stenosis.
03For valve-in-valve replacement of a degenerated bioprosthetic aortic valve, the criteria are a Society of Thoracic Surgeons operative risk score of 8% or greater, or a judged 15% or greater risk of mortality for surgical aortic valve replacement.
04For transcatheter closure of paravalvular leak (CPT 93590 - 93592), the policy considers the procedure medically necessary when all of these conditions are met: the member has intractable hemolysis or NYHA class III or IV symptoms, the member is at high or prohibitive risk for surgery, the member has anatomic features suitable for catheter-based therapy, and the procedure is performed at a comprehensive valve center.
05Do not bill BASILICA, combined TAVI and left atrial appendage occlusion, TAVI with pre-implantation balloon aortic valvuloplasty, or use of embolic protection devices during TAVI, because the policy lists these as experimental, investigational or unproven.

Codes mentioned

33361333623336333364333653336633367333683336933370929869359093592I06.0I08.0I35.0I35.9Q23.0T82.01XAT82.01XST82.03XAT82.03XST82.857AT82.857SZ45.09I06.1I33.0I33.9I70.0N17.0N17.9N99.0Q23.1A40.0A40.9A41.01A41.9T80.211AT80.29XST81.40XAT81.49XST88.0XXAT88.0XXS

Original notice

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2026-10-28)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)MediumNo effective date · SurgerySelected Aortic Valve Procedures (CPB 0407, reviewed 2026-07-07)MediumNo effective date · Medical PolicyBalloon Valvuloplasty (CPB 0477, reviewed 2026-07-17)MediumNo effective date · Medical PolicyInfectious Diseases: Selected Tests (CPB 1008, reviewed 2026-01-14)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesCardiologyCardiothoracic SurgeryCode 33361Code 33362Code 33363Code 33364Code 33365Code 33366Code 33367Code 33368Code 33369Code 33370Code 92986Code 93590Code 93592Code I06.0Code I08.0Code I35.0Code I35.9Code Q23.0Code T82.01XACode T82.01XSCode T82.03XACode T82.03XSCode T82.857ACode T82.857SCode Z45.09Code I06.1Code I33.0Code I33.9Code I70.0Code N17.0Code N17.9Code N99.0Code Q23.1Code A40.0Code A40.9Code A41.01Code A41.9Code T80.211ACode T80.29XSCode T81.40XACode T81.49XSCode T88.0XXACode T88.0XXS

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