Operative tissue ablation and reconstruction of atria, extensive (e.g., maze procedure) without cardiopulmonary bypass Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis (eg, asymmetric septal hypertrophy)ĬPT codes not covered for indications listed in the CPB:
#CPT CODE OF ATRIAL FLUTTER ABLATION CODE#
Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), extensive (e.g., maze procedure), with cardiopulmonary bypass (List separately in addition to code for primary procedure) Operative tissue ablation and reconstruction of atria, performed at the time of other cardiac procedure(s), limited (e.g., modified maze procedure) (List separately in addition to code for primary procedure) Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure) with cardiopulmonary bypass Operative tissue ablation and reconstruction of atria, limited (e.g., modified maze procedure) Codes requiring a 7th character are represented by "+":ĬPT codes covered if selection criteria are met: Information in the below has been added for clarification purposes. Table: CPT Codes / HCPCS Codes / ICD-10 Codes Code Minimally invasive, off-pump Maze procedures (including the hybrid Maze and the Convergent hybrid procedure), also known as thoracoscopic off-pump surgical ablation (TOPS).Maze procedure for all other indications (except for the one listed above).The following procedures are considered experimental and investigational because the effectiveness of these approaches has not been established:
#CPT CODE OF ATRIAL FLUTTER ABLATION PLUS#
Documented long-standing atrial fibrillation in members with mitral valve disease undergoing open surgical repair of the mitral valve.Īetna considers concomitant Maze and septal myectomy medically necessary for the treatment of hypertrophic obstructive cardiomyopathy plus refractory atrial fibrillation/flutter.A previous episode of thromboembolism when other sources of emboli have been ruled out, or.Member is at high-risk for thromboembolism as evidenced by either:.Member is suffering the hemodynamic consequences of chronic atrial fibrillation/flutter despite adequate attempts at medical management or.Member can not tolerate the side effects of drug therapy (adequate documentation of the nature and extent of the intolerance is required) or.This Clinical Policy Bulletin addresses maze procedure.Īetna considers the Maze procedure, performed with cardiopulmonary bypass on a beating heart, medically necessary for members with atrial fibrillation/flutter when any of the following criteria is met: Number: 0225 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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