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Independence Blue CrossMedicare Advantage · Coverage · Medical Policy · Cardiology, Cardiothoracic Surgery, Critical Care +1 moreMedium impact

MA05.038, Cardiac Contractility Modulation

Act
by Jan 1, 2026
Effective date
Oct 28, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage has issued a new medical policy (MA05.038) establishing coverage for Cardiac Contractility Modulation (CCM) therapy for heart failure under a Coverage with Evidence Development (CED) framework, effective retroactively to October 28, 2025. The policy adds 13 new CPT codes, 2 HCPCS codes, and 1 ICD-10 code for CCM procedures and devices, requiring strict documentation of optimized medical therapy and exclusion criteria.

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What to do

by Jan 1, 2026 · 7 steps
01Billing team must update billing system to recognize CPT codes 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T, 0948T, 0949T and HCPCS codes C1824, K1030 as medically necessary under CED criteria for Independence Blue Cross Medicare Advantage members.
02Implement requirement to append Modifier Q0 to all CCM procedure codes to indicate investigational clinical service in CMS-approved study.
03Establish pre-authorization workflow requiring documentation of: (a) FDA market-authorized indication, (b) minimum 3 months of optimized guideline-directed medical therapy (GDMT) approved by heart team, (c) verification of patient eligibility (age ≥18, no heart transplant history, no FDA contraindications).
04Update claim submission protocols to route all CCM claims for CED trial participants to the Medicare Advantage plan with required modifier Q0.
05Providers and billing staff must verify member enrollment in approved CMS CED clinical trial before processing claims.
06Failure to include proper documentation and Modifier Q0 will result in claim denials.
07Reference CMS website links for current approved CED and IDE study lists prior to claim submission.

Codes mentioned

C1824K1030Z00.06

Original notice

MA05.038, Cardiac Contractility Modulation
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA05.038, Cardiac Contractility ModulationMediumEffective Oct 28, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesCardiologyCardiothoracic SurgeryCritical CareInternal MedicineCode C1824Code K1030Code Z00.06

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