Ventricular Assist Devices — CPB 0654 | AETNA Coverage Update

TL;DR: Aetna modified CPB 0654 governing ventricular assist device coverage policy, effective February 27, 2026. Billing teams coding CPT 33975–33980, 33981–33997, 92970, 92971, 93750, and the full Q0477–Q0502 HCPCS series need to confirm their documentation aligns with updated medical necessity criteria before submitting claims.

---

Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Ventricular Assist Devices
Policy Code	CPB 0654
Change Type	Modified
Effective Date	2026-02-27
Impact Level	High
Specialties Affected	Cardiac surgery, interventional cardiology, advanced heart failure programs, pediatric cardiology, DME suppliers
Key Action	Audit documentation against all five destination therapy criteria before billing CPT 33979 or 33980 for implantable intracorporeal VADs

---

Aetna Ventricular Assist Device Coverage Criteria and Medical Necessity Requirements 2026

Aetna's CPB 0654 divides VAD coverage into four device categories: durable implantable VADs, percutaneous VADs (pVADs), pediatric VADs, and short-term LVADs/RVADs/BiVADs. Each category carries its own medical necessity criteria. Getting one wrong means a claim denial — and with devices at this cost level, that's not a recoverable error.

Bridge to transplant is the simplest path to coverage. Aetna covers FDA-approved VADs as a bridge to transplant for members awaiting heart transplantation, provided the specific device carries FDA approval for that indication. The HeartMate 3 LVAS is the named example. Bill the insertion using CPT 33979 for implantable intracorporeal single ventricle placement and confirm your documentation references the bridge-to-transplant indication explicitly.

Destination therapy is where most billing teams run into problems. Aetna requires all five of the following criteria to be met — not most, not the clinical judgment equivalent of most. All five:

That fifth criterion — peak VO₂ — has a waiver provision. If the member is balloon pump or IV inotrope dependent, or otherwise unable to complete exercise stress testing, Aetna will waive it. Document the reason for waiver explicitly in the clinical notes. If you bill CPT 33979 or 33980 for destination therapy without that documentation, you're handing a denial back to the payer on a silver platter.

Refractory electrical storm is the third covered VAD indication. Members who have tried and failed anti-arrhythmic drugs, deep sedation, and catheter ablation — or who had a failed ablation attempt — qualify. "Rhythm appears ablatable" is Aetna's qualifier for the catheter ablation requirement, so your clinical documentation needs to address whether ablation was attempted or why it wasn't the right approach. Related codes 93654 and 93655 for catheter ablation appear in the policy's related-codes list for this reason.

Percutaneous VADs — devices like TandemHeart and Impella, billed under CPT 33990 and 33991 — cover two indications: short-term circulatory support in cardiogenic shock, and adjunct support during high-risk PCI. The PCI pathway has three sub-criteria, each with an ejection fraction threshold. Unprotected left main PCI requires EF below 35%. Last-remaining-conduit PCI requires EF below 35%. Three-vessel disease requires EF below 30%. Bill CPT 33992 for removal at a separate session and CPT 33993 for repositioning. Note that pVADs during ventricular tachycardia ablation are explicitly experimental under this coverage policy — see the exclusions section below.

Pediatric VADs require documented end-stage left ventricular failure and use of an age- and size-appropriate FDA-approved device. The Berlin Heart EXCOR covers children 16 and under up to 60 kg. The HeartAssist 5 covers children aged 5 to 16 with a BSA between 0.7 m² and 1.5 m². Document the specific device, the child's age, weight, and BSA in the pre-authorization submission. Check your Aetna contract and plan-level requirements for prior authorization obligations, as the policy itself does not specify PA requirements.

---

Aetna Ventricular Assist Device Exclusions and Non-Covered Indications

Aetna's CPB 0654 treats several VAD-adjacent technologies as experimental, investigational, or unproven. The policy uses that designation when there's "insufficient evidence in the peer-reviewed literature."

Percutaneous VADs during VT ablation are explicitly excluded. If your electrophysiology program uses Impella support during ventricular tachycardia ablation procedures — an increasingly common practice — Aetna will not cover it under this policy. CPT 93654 and 93655 appear in the related-codes list, but pVAD support in that setting is out. Document this clearly in your pre-procedure planning. If you believe medical necessity exists, talk to your compliance officer before billing.

Aortic counterpulsation ventricular assist systems — billed under the Category III CPT codes 0451T–0463T — are not covered for any indication listed in CPB 0654. This includes insertion, replacement, removal, relocation, repositioning, programming evaluation, and interrogation of permanently implantable aortic counterpulsation devices. These codes sit in the "not covered" bucket regardless of patient presentation. Don't attempt to get prior authorization for these — Aetna's position is the evidence base doesn't support coverage.

Mitral valve procedures (CPT 33418, 33419, 33425, 33426, 33427, 33430) and hematopoietic progenitor cell harvesting (CPT 38205, 38206) also appear in the not-covered list. These are likely included because they appear in clinical pathways alongside VAD therapy, but they're not covered under this CPB. If your team is bundling any of these codes with VAD procedures, separate the billing and confirm each has its own coverage basis.

Any VAD indication not explicitly listed in the covered categories is experimental by default under this policy. The policy designates unlisted indications as experimental without specifying appeals procedures. If you're submitting claims for indications outside Aetna's approved list, loop in your compliance officer before the February 27, 2026 effective date.

---

Coverage Indications at a Glance

---

Aetna Ventricular Assist Device Billing Guidelines and Action Items 2026

The effective date of February 27, 2026 is your benchmark. Any claim for CPT 33975–33997 or HCPCS Q0477–Q0502 submitted on or after that date should reflect these criteria.

Copy Action Items

---

CPT, HCPCS, and ICD-10 Codes for Ventricular Assist Devices Under CPB 0654

Covered CPT Codes (When Selection Criteria Are Met)

†CPT 55880 (ablation of malignant prostate tissue via HIFU) appears in the CPB 0654 covered codes list. This code appears unrelated to VAD therapy and may reflect a policy data anomaly. Do not bill this code under CPB 0654 for VAD-related claims without direct confirmation from Aetna.

Not Covered / Experimental CPT Codes

Covered HCPCS Codes — VAD Accessories and DME Components (When Selection Criteria Are Met)

No ICD-10-CM codes are listed in CPB 0654. Consult your coding team and payer billing guidelines for applicable diagnosis codes based on clinical documentation.

---