Aetna · Clinical coverage policy

Aetna Cardioverter-Defibrillators coverage criteria

Aetna covers FDA-approved implantable cardioverter-defibrillators (ICDs), subcutaneous/extravascular ICDs, and wearable/non-wearable cardioverter-defibrillators (WCDs) for specific arrhythmia and cardiomyopathy indications — including prior VF/sustained VT, post-MI ischemic and non-ischemic cardiomyopathy with low LVEF on optimal medical therapy, and high-risk inherited conditions (e.g., Long QT, HCM, ARVC, Brugada). The key gate is meeting one of the listed device-specific indications except where contraindicated; defibrillators are not medically necessary when other disease processes clearly and severely limit life expectancy, and several add-ons/indications (hemodynamic-monitoring ICDs, ICDs with LVADs, post-CABG/PTCA WCDs in persons not meeting any of the covered indications, and any other indications) are experimental/investigational.

Policy CPB 0585 · Effective · Verify against the current Aetna policy before submitting — view source policy.

Payer

Aetna

Policy

CPB 0585

Prior auth

Confirm

Effective

August 10, 1995

This page reflects the coverage criteria captured from Aetna policy CPB 0585 and may not include every criterion, exception, or code — verify the complete bulletin before submitting.

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

When does Aetna cover Cardioverter-Defibrillators (CPT 33216), and what gets it denied?

Path
Aetna covers FDA-approved implantable cardioverter-defibrillators (ICDs), subcutaneous/extravascular ICDs, and wearable/non-wearable cardioverter-defibrillators (WCDs) for specific arrhythmia and cardiomyopathy indications — including prior VF/sustained VT, post-MI ischemic and non-ischemic cardiomyopathy with low LVEF on optimal medical therapy, and high-risk inherited conditions (e.g., Long QT, HCM, ARVC, Brugada). The key gate is meeting one of the listed device-specific indications except where contraindicated; defibrillators are not medically necessary when other disease processes clearly and severely limit life expectancy, and several add-ons/indications (hemodynamic-monitoring ICDs, ICDs with LVADs, post-CABG/PTCA WCDs in persons not meeting any of the covered indications, and any other indications) are experimental/investigational. Coverage criteria include: ICD coverage gate: Aetna considers FDA-approved implantable cardioverter-defibrillators (thoracotomy and non-thoracotomy systems) medically necessary for members with ANY of the following indications, EXCEPT where contraindicated.; ICD: After one or more episodes of spontaneously occurring ventricular fibrillation (VF) or sustained (greater than 30 seconds) ventricular tachycardia (VT) that is not associated with acute myocardial infarction (AMI), and not due to a remediable cause (examples include drug toxicity, electrolyte abnormalities, ischemia).; ICD: After VT/VF cardiac arrest that was not associated with an inducible ventricular arrhythmia, and not due to AMI.; ICD: Inducible VF or sustained VT.; ICD: After unexplained syncope which by history and clinical circumstances was probably due to a ventricular tachyarrhythmia, with EITHER: (a) reproducible inducible syncopal/hypotensive VT or VF (not associated with AMI, not due to a remediable cause), AND antiarrhythmic medications are ineffective/not tolerated/contraindicated, AND catheter ablation has failed or is not possible; OR (b) significant LV dysfunction (LVEF less than 50%) and structural heart disease (prior MI, congenital heart disease (CHD), ventricular dysfunction).; ICD (ischemic dilated cardiomyopathy) — ANY one of: (a) NYHA Class II or III heart failure with LVEF 35% or less, at least 40 days post-MI, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic), and at least 90 days post-revascularization; OR (b) NYHA Class I heart failure with LVEF 30% or less, at least 40 days post-MI, on optimal medical therapy, and at least 90 days post-revascularization; OR (c) non-sustained VT due to prior MI, LVEF 40% or less, and inducible VF or sustained VT at EP study performed at least 96 hours post-revascularization or post-MI.; Ischemic cardiomyopathy is defined as left ventricular systolic dysfunction associated with marked stenosis (at least 75% narrowing) of at least 1 of the 3 major coronary arteries, or a documented history of myocardial infarction.; ICD (non-ischemic dilated cardiomyopathy): NYHA Class II or III heart failure, LVEF 35% or less, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic).; ICD (Long QT Syndrome) with EITHER: syncope and/or VT while on beta-blockers; OR asymptomatic with ONE OR MORE risk factors (QTc greater than 500 msec; LQT2 or LQT3 genotype; family history of sudden death).; ICD (Hypertrophic cardiomyopathy or ARVC) with ONE OR MORE of: documented VT; family history of sudden cardiac death (at least 1 first-degree relative); LV thickness 3 cm or greater; hypotensive response to exercise treadmill testing; at least 1 episode of unheralded syncope within the prior 12 months.; ICD (Catecholaminergic polymorphic VT): members who have syncope and/or documented sustained VT while receiving beta-blockers.; ICD (Brugada Syndrome): members who have had syncope or who have documented or inducible VT.; ICD (LV non-compaction cardiomyopathy) with EITHER: positive family history of sudden cardiac death; OR impaired LVEF (less than 50%).; ICD (Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease): covered regardless of LV ejection fraction.; ICD: implantation may be considered in affected members with a familial cardiomyopathy associated with sudden death.; ICD replacement: Aetna considers replacement of an implantable cardioverter-defibrillator pulse generator and/or leads medically necessary when damaged, malfunctioning, when replacement is recommended according to the manufacturer's instructions in the product labeling, or due to a change in the member's medical condition.; Extravascular / subcutaneous cardioverter-defibrillators (S-ICD): FDA-approved S-ICDs are covered for persons who meet medical necessity criteria for an ICD listed above AND who do NOT have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing, OR who have previous endocarditis or infection associated with conventional ICDs.; WCD coverage gate: Wearable and non-wearable cardioverter-defibrillators (WCDs) are covered as durable medical equipment for members meeting ANY of the WCD criteria below.; WCD: A documented episode of VF or a sustained (lasting 30 seconds or longer) VT (these dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study, but may not be due to a transient or reversible cause and may not occur during the first 48 hours of an AMI).; WCD: A previously implanted defibrillator now requires explantation.; WCD: Member meets the above-listed criteria for an ICD and is awaiting heart transplantation.; WCD: Member meets the above-listed criteria for an ICD and has a systemic infectious process or other temporary condition that precludes ICD implantation.; WCD: Either documented prior myocardial infarction or dilated cardiomyopathy and a measured LVEF 35% or less, in whom the duration of decreased LVEF is less than 90 days, and a recheck of LVEF is planned at 90 days. After the initial 90-day approval, an extension on a month-to-month basis may be obtained to bridge the time until AICD implant or heart transplant; the wearable device has no indication for extended usage if a destination therapy is not planned.; WCD: Familial or inherited conditions with a high risk of life-threatening VT such as long QT syndrome or hypertrophic cardiomyopathy (for the NON-wearable device only, a caregiver must be present in the home capable of operating the device).; Electrophysiologic assessment (a more complex evaluation of cardioverter-defibrillators) is considered medically necessary.; Electronic analysis of defibrillator systems is required (and medically necessary) for long-term routine follow-up care.; Automatic defibrillator monitoring is considered medically necessary.. Applies to 27 codes: 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33226, 33230, 33231, 33240, 33241, 33249, 33262, 33263, 33264, 33270, 33271, 93260, 93261, 93644, 93745, C1721, C1722, C1882, E0617, K0606.
Action
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
Trap
Policy exclusions and limitations: Experimental/investigational/unproven: ICDs with hemodynamic (fluid status) monitoring.; Experimental/investigational/unproven: Use of implantable cardioverter-defibrillators in persons with left ventricular assist devices (LVADs).; Experimental/investigational/unproven: N-terminal pro-B type natriuretic peptide for assessing prognosis of cardioverter-defibrillator implantation.; Experimental/investigational/unproven: WCDs and non-wearable cardioverter-defibrillators for use after CABG or PTCA (in persons not meeting any of the above indications) or for all other indications.; Experimental/investigational/unproven: Extravascular / subcutaneous cardioverter-defibrillators for all other indications (beyond the listed S-ICD criteria), because their effectiveness and safety have not been established.; Experimental/investigational/unproven: Implantable cardioverter-defibrillators for other indications (beyond the listed ICD criteria), because their safety and effectiveness have not been established.; Not medically necessary: Cardioverter-defibrillators are not considered medically necessary when other disease processes are present that clearly and severely limit the member's life expectancy.; S-ICD non-coverage as contraindication: Subcutaneous/extravascular cardioverter-defibrillators are not covered for persons who have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing (i.e., who require those pacing functions). Claims may be denied when the requested service falls under these.

Source: Aetna CPB 0585 — Cardioverter-Defibrillators

Coverage criteria

  • ICD coverage gate: Aetna considers FDA-approved implantable cardioverter-defibrillators (thoracotomy and non-thoracotomy systems) medically necessary for members with ANY of the following indications, EXCEPT where contraindicated.
  • ICD: After one or more episodes of spontaneously occurring ventricular fibrillation (VF) or sustained (greater than 30 seconds) ventricular tachycardia (VT) that is not associated with acute myocardial infarction (AMI), and not due to a remediable cause (examples include drug toxicity, electrolyte abnormalities, ischemia).
  • ICD: After VT/VF cardiac arrest that was not associated with an inducible ventricular arrhythmia, and not due to AMI.
  • ICD: Inducible VF or sustained VT.
  • ICD: After unexplained syncope which by history and clinical circumstances was probably due to a ventricular tachyarrhythmia, with EITHER: (a) reproducible inducible syncopal/hypotensive VT or VF (not associated with AMI, not due to a remediable cause), AND antiarrhythmic medications are ineffective/not tolerated/contraindicated, AND catheter ablation has failed or is not possible; OR (b) significant LV dysfunction (LVEF less than 50%) and structural heart disease (prior MI, congenital heart disease (CHD), ventricular dysfunction).
  • ICD (ischemic dilated cardiomyopathy) — ANY one of: (a) NYHA Class II or III heart failure with LVEF 35% or less, at least 40 days post-MI, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic), and at least 90 days post-revascularization; OR (b) NYHA Class I heart failure with LVEF 30% or less, at least 40 days post-MI, on optimal medical therapy, and at least 90 days post-revascularization; OR (c) non-sustained VT due to prior MI, LVEF 40% or less, and inducible VF or sustained VT at EP study performed at least 96 hours post-revascularization or post-MI.
  • Ischemic cardiomyopathy is defined as left ventricular systolic dysfunction associated with marked stenosis (at least 75% narrowing) of at least 1 of the 3 major coronary arteries, or a documented history of myocardial infarction.
  • ICD (non-ischemic dilated cardiomyopathy): NYHA Class II or III heart failure, LVEF 35% or less, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic).
  • ICD (Long QT Syndrome) with EITHER: syncope and/or VT while on beta-blockers; OR asymptomatic with ONE OR MORE risk factors (QTc greater than 500 msec; LQT2 or LQT3 genotype; family history of sudden death).
  • ICD (Hypertrophic cardiomyopathy or ARVC) with ONE OR MORE of: documented VT; family history of sudden cardiac death (at least 1 first-degree relative); LV thickness 3 cm or greater; hypotensive response to exercise treadmill testing; at least 1 episode of unheralded syncope within the prior 12 months.
  • ICD (Catecholaminergic polymorphic VT): members who have syncope and/or documented sustained VT while receiving beta-blockers.
  • ICD (Brugada Syndrome): members who have had syncope or who have documented or inducible VT.
  • ICD (LV non-compaction cardiomyopathy) with EITHER: positive family history of sudden cardiac death; OR impaired LVEF (less than 50%).
  • ICD (Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease): covered regardless of LV ejection fraction.
  • ICD: implantation may be considered in affected members with a familial cardiomyopathy associated with sudden death.
  • ICD replacement: Aetna considers replacement of an implantable cardioverter-defibrillator pulse generator and/or leads medically necessary when damaged, malfunctioning, when replacement is recommended according to the manufacturer's instructions in the product labeling, or due to a change in the member's medical condition.
  • Extravascular / subcutaneous cardioverter-defibrillators (S-ICD): FDA-approved S-ICDs are covered for persons who meet medical necessity criteria for an ICD listed above AND who do NOT have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing, OR who have previous endocarditis or infection associated with conventional ICDs.
  • WCD coverage gate: Wearable and non-wearable cardioverter-defibrillators (WCDs) are covered as durable medical equipment for members meeting ANY of the WCD criteria below.
  • WCD: A documented episode of VF or a sustained (lasting 30 seconds or longer) VT (these dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study, but may not be due to a transient or reversible cause and may not occur during the first 48 hours of an AMI).
  • WCD: A previously implanted defibrillator now requires explantation.
  • WCD: Member meets the above-listed criteria for an ICD and is awaiting heart transplantation.
  • WCD: Member meets the above-listed criteria for an ICD and has a systemic infectious process or other temporary condition that precludes ICD implantation.
  • WCD: Either documented prior myocardial infarction or dilated cardiomyopathy and a measured LVEF 35% or less, in whom the duration of decreased LVEF is less than 90 days, and a recheck of LVEF is planned at 90 days. After the initial 90-day approval, an extension on a month-to-month basis may be obtained to bridge the time until AICD implant or heart transplant; the wearable device has no indication for extended usage if a destination therapy is not planned.
  • WCD: Familial or inherited conditions with a high risk of life-threatening VT such as long QT syndrome or hypertrophic cardiomyopathy (for the NON-wearable device only, a caregiver must be present in the home capable of operating the device).
  • Electrophysiologic assessment (a more complex evaluation of cardioverter-defibrillators) is considered medically necessary.
  • Electronic analysis of defibrillator systems is required (and medically necessary) for long-term routine follow-up care.
  • Automatic defibrillator monitoring is considered medically necessary.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

Frequently asked questions

When does Aetna cover Cardioverter-Defibrillators (CPT 33216), and what gets it denied?
Aetna covers FDA-approved implantable cardioverter-defibrillators (ICDs), subcutaneous/extravascular ICDs, and wearable/non-wearable cardioverter-defibrillators (WCDs) for specific arrhythmia and cardiomyopathy indications — including prior VF/sustained VT, post-MI ischemic and non-ischemic cardiomyopathy with low LVEF on optimal medical therapy, and high-risk inherited conditions (e.g., Long QT, HCM, ARVC, Brugada). The key gate is meeting one of the listed device-specific indications except where contraindicated; defibrillators are not medically necessary when other disease processes clearly and severely limit life expectancy, and several add-ons/indications (hemodynamic-monitoring ICDs, ICDs with LVADs, post-CABG/PTCA WCDs in persons not meeting any of the covered indications, and any other indications) are experimental/investigational. Coverage criteria include: ICD coverage gate: Aetna considers FDA-approved implantable cardioverter-defibrillators (thoracotomy and non-thoracotomy systems) medically necessary for members with ANY of the following indications, EXCEPT where contraindicated.; ICD: After one or more episodes of spontaneously occurring ventricular fibrillation (VF) or sustained (greater than 30 seconds) ventricular tachycardia (VT) that is not associated with acute myocardial infarction (AMI), and not due to a remediable cause (examples include drug toxicity, electrolyte abnormalities, ischemia).; ICD: After VT/VF cardiac arrest that was not associated with an inducible ventricular arrhythmia, and not due to AMI.; ICD: Inducible VF or sustained VT.; ICD: After unexplained syncope which by history and clinical circumstances was probably due to a ventricular tachyarrhythmia, with EITHER: (a) reproducible inducible syncopal/hypotensive VT or VF (not associated with AMI, not due to a remediable cause), AND antiarrhythmic medications are ineffective/not tolerated/contraindicated, AND catheter ablation has failed or is not possible; OR (b) significant LV dysfunction (LVEF less than 50%) and structural heart disease (prior MI, congenital heart disease (CHD), ventricular dysfunction).; ICD (ischemic dilated cardiomyopathy) — ANY one of: (a) NYHA Class II or III heart failure with LVEF 35% or less, at least 40 days post-MI, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic), and at least 90 days post-revascularization; OR (b) NYHA Class I heart failure with LVEF 30% or less, at least 40 days post-MI, on optimal medical therapy, and at least 90 days post-revascularization; OR (c) non-sustained VT due to prior MI, LVEF 40% or less, and inducible VF or sustained VT at EP study performed at least 96 hours post-revascularization or post-MI.; Ischemic cardiomyopathy is defined as left ventricular systolic dysfunction associated with marked stenosis (at least 75% narrowing) of at least 1 of the 3 major coronary arteries, or a documented history of myocardial infarction.; ICD (non-ischemic dilated cardiomyopathy): NYHA Class II or III heart failure, LVEF 35% or less, on optimal medical therapy (3 months of maximally titrated doses as tolerated of an ACE inhibitor, beta-blocker, and diuretic).; ICD (Long QT Syndrome) with EITHER: syncope and/or VT while on beta-blockers; OR asymptomatic with ONE OR MORE risk factors (QTc greater than 500 msec; LQT2 or LQT3 genotype; family history of sudden death).; ICD (Hypertrophic cardiomyopathy or ARVC) with ONE OR MORE of: documented VT; family history of sudden cardiac death (at least 1 first-degree relative); LV thickness 3 cm or greater; hypotensive response to exercise treadmill testing; at least 1 episode of unheralded syncope within the prior 12 months.; ICD (Catecholaminergic polymorphic VT): members who have syncope and/or documented sustained VT while receiving beta-blockers.; ICD (Brugada Syndrome): members who have had syncope or who have documented or inducible VT.; ICD (LV non-compaction cardiomyopathy) with EITHER: positive family history of sudden cardiac death; OR impaired LVEF (less than 50%).; ICD (Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease): covered regardless of LV ejection fraction.; ICD: implantation may be considered in affected members with a familial cardiomyopathy associated with sudden death.; ICD replacement: Aetna considers replacement of an implantable cardioverter-defibrillator pulse generator and/or leads medically necessary when damaged, malfunctioning, when replacement is recommended according to the manufacturer's instructions in the product labeling, or due to a change in the member's medical condition.; Extravascular / subcutaneous cardioverter-defibrillators (S-ICD): FDA-approved S-ICDs are covered for persons who meet medical necessity criteria for an ICD listed above AND who do NOT have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing, OR who have previous endocarditis or infection associated with conventional ICDs.; WCD coverage gate: Wearable and non-wearable cardioverter-defibrillators (WCDs) are covered as durable medical equipment for members meeting ANY of the WCD criteria below.; WCD: A documented episode of VF or a sustained (lasting 30 seconds or longer) VT (these dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study, but may not be due to a transient or reversible cause and may not occur during the first 48 hours of an AMI).; WCD: A previously implanted defibrillator now requires explantation.; WCD: Member meets the above-listed criteria for an ICD and is awaiting heart transplantation.; WCD: Member meets the above-listed criteria for an ICD and has a systemic infectious process or other temporary condition that precludes ICD implantation.; WCD: Either documented prior myocardial infarction or dilated cardiomyopathy and a measured LVEF 35% or less, in whom the duration of decreased LVEF is less than 90 days, and a recheck of LVEF is planned at 90 days. After the initial 90-day approval, an extension on a month-to-month basis may be obtained to bridge the time until AICD implant or heart transplant; the wearable device has no indication for extended usage if a destination therapy is not planned.; WCD: Familial or inherited conditions with a high risk of life-threatening VT such as long QT syndrome or hypertrophic cardiomyopathy (for the NON-wearable device only, a caregiver must be present in the home capable of operating the device).; Electrophysiologic assessment (a more complex evaluation of cardioverter-defibrillators) is considered medically necessary.; Electronic analysis of defibrillator systems is required (and medically necessary) for long-term routine follow-up care.; Automatic defibrillator monitoring is considered medically necessary.. Applies to 27 codes: 33216, 33217, 33218, 33220, 33223, 33224, 33225, 33226, 33230, 33231, 33240, 33241, 33249, 33262, 33263, 33264, 33270, 33271, 93260, 93261, 93644, 93745, C1721, C1722, C1882, E0617, K0606. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Policy exclusions and limitations: Experimental/investigational/unproven: ICDs with hemodynamic (fluid status) monitoring.; Experimental/investigational/unproven: Use of implantable cardioverter-defibrillators in persons with left ventricular assist devices (LVADs).; Experimental/investigational/unproven: N-terminal pro-B type natriuretic peptide for assessing prognosis of cardioverter-defibrillator implantation.; Experimental/investigational/unproven: WCDs and non-wearable cardioverter-defibrillators for use after CABG or PTCA (in persons not meeting any of the above indications) or for all other indications.; Experimental/investigational/unproven: Extravascular / subcutaneous cardioverter-defibrillators for all other indications (beyond the listed S-ICD criteria), because their effectiveness and safety have not been established.; Experimental/investigational/unproven: Implantable cardioverter-defibrillators for other indications (beyond the listed ICD criteria), because their safety and effectiveness have not been established.; Not medically necessary: Cardioverter-defibrillators are not considered medically necessary when other disease processes are present that clearly and severely limit the member's life expectancy.; S-ICD non-coverage as contraindication: Subcutaneous/extravascular cardioverter-defibrillators are not covered for persons who have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing (i.e., who require those pacing functions). Claims may be denied when the requested service falls under these.
Does Aetna require prior authorization for Cardioverter-Defibrillators?
Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source.
What does Aetna exclude for Cardioverter-Defibrillators?
Policy exclusions and limitations: Experimental/investigational/unproven: ICDs with hemodynamic (fluid status) monitoring.; Experimental/investigational/unproven: Use of implantable cardioverter-defibrillators in persons with left ventricular assist devices (LVADs).; Experimental/investigational/unproven: N-terminal pro-B type natriuretic peptide for assessing prognosis of cardioverter-defibrillator implantation.; Experimental/investigational/unproven: WCDs and non-wearable cardioverter-defibrillators for use after CABG or PTCA (in persons not meeting any of the above indications) or for all other indications.; Experimental/investigational/unproven: Extravascular / subcutaneous cardioverter-defibrillators for all other indications (beyond the listed S-ICD criteria), because their effectiveness and safety have not been established.; Experimental/investigational/unproven: Implantable cardioverter-defibrillators for other indications (beyond the listed ICD criteria), because their safety and effectiveness have not been established.; Not medically necessary: Cardioverter-defibrillators are not considered medically necessary when other disease processes are present that clearly and severely limit the member's life expectancy.; S-ICD non-coverage as contraindication: Subcutaneous/extravascular cardioverter-defibrillators are not covered for persons who have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing (i.e., who require those pacing functions). Claims may be denied when the requested service falls under these.

Source

Aetna CPB 0585 — Cardioverter-Defibrillators

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Coverage disclaimer

This page summarizes Aetna clinical-coverage criteria extracted from policy CPB 0585 for educational purposes. Coverage policies change and vary by individual plan. Always verify against Aetna's current policy before performing a procedure or submitting a claim. d3rx is not responsible for claim denials or reimbursement issues.