Catheter-Directed Cardiac Procedures — CPB 0292 | AETNA Coverage Update

Aetna modified CPB 0292, its catheter-directed cardiac procedures coverage policy, effective September 26, 2025. Here's what billing teams need to do.

Aetna, a CVS Health company, updated CPB 0292 to address catheter-directed cardiac procedures — a policy that covers CPT codes 93580, 93581, and 93582 for percutaneous transcatheter closures of congenital heart defects, and HCPCS C1817 for intracardiac septal defect implant systems. The update also draws a hard line on CPT 0613T, the code for percutaneous transcatheter implantation of an interatrial septal shunt device — Aetna does not cover it. If your team bills for structural heart procedures in Aetna's commercial population, this policy change deserves your attention before claims start hitting the wall.

Quick-Reference Table

Aetna Catheter-Directed Cardiac Procedures Coverage Criteria and Medical Necessity Requirements 2025

The Aetna catheter-directed cardiac procedures coverage policy under CPB 0292 Aetna system covers three core transcatheter closure procedures when specific medical necessity criteria are met. Those three are CPT 93580 (percutaneous transcatheter closure of congenital interatrial communication, including Fontan fenestration), CPT 93581 (percutaneous transcatheter closure of a congenital ventricular septal defect with implant), and CPT 93582 (percutaneous transcatheter closure of patent ductus arteriosus).

The word "when selection criteria are met" is doing a lot of work here. Aetna won't pay for these procedures just because the anatomical defect exists. Medical necessity documentation has to tie the procedure to the right diagnosis codes. The ICD-10 codes Aetna maps to covered indications include Q21.0 (ventricular septal defect), Q21.10–Q21.19 (atrial septal defects, with important carve-outs — more on that below), I23.1 and I23.2 (septal defects as complications following acute MI), and I51.0 (acquired cardiac septal defect).

Aetna's coverage policy also extends to septal closure in the context of cryptogenic stroke (I63.9) and transient ischemic attacks (G45.0–G45.9) — presumably where a patent foramen ovale or other interatrial communication is the suspected embolic source. Migraine diagnoses (G43.001–G43.E19) and vascular headache (G44.1) also appear in the ICD-10 mapping. That's a notable inclusion and likely reflects ongoing clinical debate about percutaneous PFO closure for migraine. Don't assume those are clean approvals — verify medical necessity documentation is airtight before billing.

On prior authorization: Aetna routinely requires prior auth for interventional cardiac procedures. Verify current prior authorization requirements through Aetna's provider portal for each procedure before scheduling. Reimbursement denials for missing auth are avoidable — don't let that be your problem.

Aetna Catheter-Directed Cardiac Procedures Exclusions and Non-Covered Indications

The clearest exclusion in CPB 0292 is CPT 0613T — percutaneous transcatheter implantation of an interatrial septal shunt device. Aetna classifies this as not covered for indications listed in the CPB. This is a Category III code tied to devices like the IASD (Interatrial Shunt Device) studied in heart failure populations. Aetna isn't buying the evidence yet, and billing 0613T for Aetna patients will produce a claim denial.

There's also an explicit carve-out within the atrial septal defect diagnosis codes. Q21.10–Q21.19 are listed as covered ICD-10 codes — but Aetna specifically excludes coronary sinus atrial septal defects and patent foramen ovale (PFO) from coverage under these codes. Read that twice. The code range looks like it covers all ASDs, but the policy note pulls PFO and coronary sinus ASDs back out.

That's a meaningful distinction for structural heart programs. PFO closure for cryptogenic stroke is listed separately under I63.9 and TIA codes — so coverage there may exist under a different pathway, but it isn't automatically captured by billing Q21.10–Q21.19. If your documentation says "PFO" and you're using an ASD diagnosis code, expect scrutiny.

The Nit-Occlud Lê VSD coil, Neovasc Reducer, and AngioVac System show up in the HCPCS section under C9783 and C9792 — both blinded or placebo-controlled procedure codes. These appear to be investigational protocol designations, not standard reimbursement pathways. If your program uses any of these devices in a trial context, talk to your compliance officer before billing. The interaction between investigational device coverage and standard coding is not something to sort out on the fly.

Coverage Indications at a Glance

Aetna Catheter-Directed Cardiac Billing Guidelines and Action Items 2025

1. Stop billing CPT 0613T for Aetna patients immediately.
This code is explicitly non-covered under CPB 0292. If your charge capture includes 0613T as a standard charge for interatrial shunt procedures, remove it from Aetna claims now. Every claim with 0613T going to Aetna will deny. The effective date of this version is September 26, 2025 — if you've submitted claims since then, audit your remits.

2. Audit your ASD diagnosis codes before the next claim cycle.
The Q21.10–Q21.19 code range looks clean, but Aetna excludes PFO and coronary sinus ASDs from coverage under those codes. Pull recent Aetna claims for CPT 93580 and check the accompanying diagnosis codes. If any claims carry Q21.1x with a documented PFO, you have exposure.

3. Map PFO closure claims to the correct pathway.
If a patient had PFO closure for cryptogenic stroke, use I63.9, G45.0–G45.9, or the relevant I65–I66 occlusion/stenosis codes — not Q21.1x. This is where catheter-directed cardiac procedures billing gets specific. The procedure code may be identical (93580), but the diagnosis code drives coverage.

4. Verify prior authorization requirements for all three covered procedure codes before scheduling.
CPT 93580, 93581, and 93582 all carry selection criteria requirements. Prior authorization requirements for these codes can vary by Aetna plan type (commercial, managed Medicaid, exchange). Check the specific plan before scheduling — not after.

5. Document medical necessity for migraine and headache indications explicitly.
If you're billing CPT 93580 with G43.x or G44.1 diagnosis codes for migraine-associated procedures, your clinical documentation has to be bulletproof. The evidence base is contested. Aetna includes these ICD-10 codes in the policy, but that's not a guarantee of approval. Get your medical director and compliance officer aligned on documentation standards for these cases before submitting.

6. Flag C9783 and C9792 claims for compliance review.
These HCPCS codes cover blinded/placebo-controlled procedures — investigational trial contexts. If your program runs clinical trials involving the Nit-Occlud Lê VSD coil, Neovasc Reducer, or AngioVac System, standard billing guidelines don't apply. Loop in your compliance officer before any claims go out under these codes.

CPT, HCPCS, and ICD-10 Codes for Catheter-Directed Cardiac Procedures Under CPB 0292

Covered CPT Codes (When Selection Criteria Are Met)

Not Covered / Experimental CPT Codes

Covered HCPCS Codes (When Selection Criteria Are Met)

HCPCS Codes — Investigational/Trial Context

Key ICD-10-CM Diagnosis Codes