CommercialCoverageHigh impact
Transcatheter Heart Valve Procedures 7.01.109
Excellus BlueCross BlueShield·Cardiology, Cardiothoracic Surgery·Heart & Blood Vessels (Cardiovascular)
Effective date
May 21, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their transcatheter heart valve procedures policy (7.01.109) effective May 21, 2026. The policy establishes specific medical necessity criteria for TAVR/TAVI procedures, mitral valve repairs, and pulmonary valve implantations, while marking tricuspid valve procedures and cerebral embolic protection devices as investigational.
Action Required
By May 21, 2026: Billing team must update prior authorization requirements for transcatheter heart valve procedures to ensure compliance with new medical necessity criteria. Verify all TAVR/TAVI claims include documentation of severe aortic stenosis, NYHA class II-IV symptoms, ejection fraction >20%, and FDA-approved device usage. Update encounter forms to prompt providers for required documentation. Claims missing these criteria will likely be denied.