Ventricular Remodeling Operation (Batista Procedure) / and Surgical Ventricular Restoration (Dor Procedure) — CPB 0182 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0182 covering ventricular remodeling and surgical ventricular restoration procedures, effective September 26, 2025. CPT codes 33542, 33548, and 0643T are not covered under this policy. Here's what billing teams need to do.

This update to the Aetna ventricular remodeling coverage policy affects cardiac surgery billing teams billing CPT 33542 (myocardial resection/ventricular aneurysmectomy) and CPT 33548 (surgical ventricular restoration procedure) for patients with diagnoses including dilated cardiomyopathy (I42.0) and the full spectrum of heart failure codes under I50. CPB 0182 Aetna is the controlling bulletin — and if your charge capture still routes these codes through standard cardiac surgery workflows expecting reimbursement, you need to stop and read this.

Quick-Reference Table

Aetna Ventricular Remodeling Coverage Criteria and Medical Necessity Requirements 2025

The short version: Aetna does not cover the Batista procedure or the Dor procedure for the indications listed in CPB 0182. That means no medical necessity pathway currently exists for CPT 33542 or CPT 33548 under this policy for heart failure or dilated cardiomyopathy diagnoses.

CPT 33548 covers surgical ventricular restoration — the Dor procedure — including use of a prosthetic patch when performed. CPT 33542 covers myocardial resection, which includes ventricular aneurysmectomy and maps to the Batista approach. Neither procedure meets Aetna's coverage policy criteria for the diagnoses this bulletin addresses.

CPT 0643T — transcatheter left ventricular restoration device implantation including right and left heart catheterization — sits in the same "not covered" bucket. This is the transcatheter version of ventricular restoration. Aetna treats all three approaches the same way under CPB 0182: not covered.

Prior authorization is not a path to reimbursement here. When a payer designates a procedure as not covered for specific indications, prior authorization doesn't flip that determination. Your team should not be spending time submitting prior auth requests for CPT 33548 or 33542 under heart failure diagnoses expecting a different result.

The associated ICD-10-CM diagnosis codes that trigger this policy include I42.0 (dilated cardiomyopathy) and the full I50 category — I50.1 through I50.9 — covering all classifications of heart failure. If your patient has one of these diagnoses and you're billing any of the three covered procedures, you're looking at a claim denial.

Aetna Ventricular Remodeling Exclusions and Non-Covered Indications

All three primary surgical and transcatheter approaches to ventricular remodeling are explicitly not covered under CPB 0182 for the indications this policy addresses.

This isn't a situation where one approach is covered and another isn't. Aetna has drawn a hard line across open surgical ventricular restoration (CPT 33548), myocardial resection (CPT 33542), and transcatheter left ventricular restoration (CPT 0643T). That consistency across modalities tells you something about how Aetna views the evidence base for these procedures.

The real issue here is that 0643T is a Category III tracking code for an emerging transcatheter technology. Aetna not covering it under CPB 0182 is consistent with how payers often treat Category III codes — as investigational until evidence accumulates. The fact that 33542 and 33548 (both established Category I codes) also sit in the "not covered" column signals that Aetna's position is about clinical evidence for these specific indications, not procedure age or technology newness.

Coverage Indications at a Glance

The CPT 33426 row deserves attention. Aetna lists it as a "related code" to CPB 0182, not in the "not covered" group. Mitral valve repair with a prosthetic ring often accompanies ventricular restoration procedures. Its coverage status under a given claim depends on the primary indication and whether it's bundled with a non-covered procedure. Talk to your compliance officer before billing 33426 alongside 33542 or 33548 on the same claim.

Aetna Ventricular Remodeling Billing Guidelines and Action Items 2025

The effective date is September 26, 2025. If your team hasn't already adjusted workflows, do it now.

CPT, HCPCS, and ICD-10 Codes for Ventricular Remodeling Under CPB 0182

Not Covered CPT Codes

These three codes are explicitly listed as "not covered for indications listed in the CPB":

Key ICD-10-CM Diagnosis Codes

These are the diagnoses that trigger CPB 0182. Claims pairing the not-covered CPT codes with any of these diagnoses will be denied under this policy:

The breadth of the I50 category here matters. This isn't limited to one type of heart failure — Aetna's not-covered position under CPB 0182 spans HFrEF (I50.2, I50.5), HFpEF (I50.7), combined systolic/diastolic failure (I50.4), and unspecified heart failure (I50.9). If the patient has heart failure of any type plus a ventricular remodeling procedure, this policy applies.