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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 Oct 28, 2025
Effective date
Oct 28, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage has issued/reissued policy MA05.038 establishing coverage for Cardiac Contractility Modulation (CCM) therapy for heart failure under a Coverage with Evidence Development (CED) framework. The policy adds 13 new CPT codes, 2 HCPCS codes, and 1 ICD-10 code, and requires CCM claims for CED trial participants to include Modifier Q0 and be submitted to the MA plan. This represents a shift from investigational/non-covered status to conditional coverage for eligible heart failure patients enrolled in CMS-approved clinical trials.

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What to do

by Oct 28, 2025 · 6 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 coverage criteria.
02Configure system to require Modifier Q0 on all CCM procedure claims for patients enrolled in CMS-approved CED clinical trials.
03Ensure claims are routed to Independence Blue Cross Medicare Advantage (not Original Medicare) for CED trial participants.
04Update clinical documentation requirements to capture: FDA market-authorized indication status, minimum 3 months of optimized guideline-directed medical therapy (GDMT) prior to implant, heart team determination, patient age (≥18), transplant status, and FDA label contraindications.
05Providers must verify patient CED trial enrollment status before claim submission.
06Clinical staff should reference CMS CED and IDE approved study lists at cms.gov for eligible trial identification.
If missed: Failure to apply Modifier Q0, verify CED enrollment, or submit required documentation will result in claim denials.

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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