Does Anthem require prior authorization for CPT 93656?

Yes. Anthem requires prior authorization for CPT 93656 (Cardiovascular procedures) under Standard commercial plans per its published clinical policy.

What documentation does Anthem require for CPT 93656?

12-lead EKG or rhythm strip documenting atrial fibrillation; Echocardiogram within 12 months; Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome; TEE or cardiac CT results for LAA assessment

How much does Medicare pay for CPT 93656 in 2026?

In 2026, the national Medicare allowable for CPT 93656 is $806.63 in an office setting and $806.63 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.

What if Anthem denies the PA for CPT 93656?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Anthem Prior Authorization for CPT 93656

Cardiovascular procedures · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified January 1, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Anthem clinical policy

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Anthem requires prior authorization for cardiac catheter ablation for AF via Carelon Medical Benefits Management. Symptomatic paroxysmal or persistent AF failed at least one antiarrhythmic drug, or contraindication/intolerance to antiarrhythmics. Documentation: EKG showing AF, echo with LVEF, antiarrhythmic trial records. TEE or cardiac CT to exclude LAA thrombus.

Documentation checklist

✓12-lead EKG or rhythm strip documenting atrial fibrillation
✓Echocardiogram within 12 months
✓Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome
✓TEE or cardiac CT results for LAA assessment

Submission channels

Phone

1-800-274-7767

2026 Medicare rate for CPT 93656

Office (non-facility)

$806.63

Facility

$806.63

Total RVUs (office)

24.15

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Anthem's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 93656 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: 12-lead EKG or rhythm strip documenting atrial fibrillation, Echocardiogram within 12 months, Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome….
3Submit via phone, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Anthem require prior authorization for CPT 93656?: Yes. Anthem requires prior authorization for CPT 93656 (Cardiovascular procedures) under Standard commercial plans per its published clinical policy.
What documentation does Anthem require for CPT 93656?: 12-lead EKG or rhythm strip documenting atrial fibrillation; Echocardiogram within 12 months; Documentation of antiarrhythmic drug trial(s) with drug names, doses, duration, and outcome; TEE or cardiac CT results for LAA assessment
How much does Medicare pay for CPT 93656 in 2026?: In 2026, the national Medicare allowable for CPT 93656 is $806.63 in an office setting and $806.63 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.
What if Anthem denies the PA for CPT 93656?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other Anthem PA lookups

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CPT 93656 prior authorization by payer

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