93592 Insurance Policy Changes

Transcatheter Aortic Valve Implantation (CPB 0826, reviewed 2025-12-03)

Aetna's TAVI (Transcatheter Aortic Valve Implantation) policy CPB 0826 establishes coverage criteria for multiple valve replacement approaches with specific FDA-approved devices and clinical risk thresholds. The policy clearly delineates covered procedures (TAVI for high-risk/inoperable patients, valve-in-valve replacements, paravalvular leak repairs) from non-covered experimental procedures (BASILICA, embolic protection devices, pre-implant balloon valvuloplasty). Billing teams must verify patient risk scores, device types, and clinical indications before claim submission to ensure medical necessity.