Aetna, a CVS Health company, modified CPB 0880 covering percutaneous mitral and tricuspid valve repair, effective January 5, 2026. Here's what changes for billing teams.
Aetna updated CPB 0880 to define medical necessity criteria for transcatheter edge-to-edge mitral valve repair and transcatheter mitral valve-in-valve replacement — and to draw a hard line around what it considers experimental for tricuspid valve procedures. The primary covered codes are 33418, 33419, 0345T, 0483T, and 0484T. The "not covered" list is long and specific, and if your charge capture isn't aligned to it, you're looking at claim denials on high-dollar structural heart procedures.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Percutaneous Mitral Valve and Tricuspid Valve Repair |
| Policy Code | CPB 0880 |
| Change Type | Modified |
| Effective Date | January 5, 2026 |
| Impact Level | High |
| Specialties Affected | Interventional Cardiology, Cardiac Surgery, Structural Heart Programs |
| Key Action | Audit charge capture and documentation for CPT 33418, 33419, 0345T, and tricuspid codes before submitting claims under this policy |
Aetna Percutaneous Valve Repair Coverage Criteria and Medical Necessity Requirements 2026
The Aetna percutaneous mitral valve repair coverage policy draws two clear coverage lines. First, transcatheter edge-to-edge repair — the MitraClip procedure billed under CPT 33418 and 33419 — is medically necessary for chronic mitral regurgitation patients who remain symptomatic on maximal medical therapy and are not surgical candidates. That's the narrow lane. If your patient can tolerate surgery, Aetna doesn't cover this route.
Second, transcatheter mitral valve-in-valve replacement (billed under 0483T and 0484T) is covered when a patient has symptomatic heart disease from a failing surgical bioprosthetic mitral valve. The heart team — which must include a cardiac surgeon — must judge the patient to be at high or greater surgical risk. Specifically, that means a predicted 30-day surgical mortality of 8% or higher based on the Society of Thoracic Surgeons (STS) score, plus any clinical comorbidities the STS calculator doesn't capture.
That STS threshold is a documentation requirement, not just a clinical guideline. If your records don't reference the STS score and the heart team's surgical risk determination, expect prior authorization problems and downstream claim denial risk on 0483T and 0484T claims.
CPT 0345T — the coronary sinus approach for mitral valve repair — is also listed as covered when selection criteria are met. This is the less common access route, but make sure your team isn't defaulting to 33418 when the approach was actually coronary sinus.
For prior authorization: Aetna CPB 0880 Aetna system policies of this type almost always require prior auth for structural heart procedures. Confirm prior authorization requirements with Aetna directly for each of these codes before scheduling. Missing prior auth on a $50,000+ case is not a recoverable billing error.
Aetna Percutaneous Valve Repair Exclusions and Non-Covered Indications
This is where CPB 0880 gets detailed — and where your billing team needs to pay close attention.
Aetna considers a long list of MitraClip indications experimental, investigational, or unproven. The policy is explicit: this is not an all-inclusive list, so the exclusions go beyond what's written. The covered MitraClip path is narrow. Everything else defaults to not covered.
Excluded MitraClip indications include:
| # | Excluded Procedure |
|---|---|
| 1 | Patients who are hemodynamically unstable — cardiogenic shock (R57.0) or refractory pulmonary edema (J81.0, J81.1) with concomitant moderate-to-severe mitral regurgitation |
| 2 | Patients who can't tolerate anticoagulation or antiplatelet medications |
| 3 | Active endocarditis (I33.x codes) |
| 4 | Intracardiac thrombus at the implant site or in access vessels |
| 5 | Patients who are candidates for open-heart surgery — this is the core exclusion. If surgery is an option, MitraClip is off the table |
| 6 | Rheumatic mitral valve disease (I05.x, I08.x) |
| 7 | Hypertrophic cardiomyopathy or severe CHF with NTproBNP greater than 10,000 pg/mL |
The rheumatic disease exclusion matters. ICD-10 codes I05.0 through I05.2 and I08.0 through I08.3 appear in the policy's diagnosis code list — but the policy notes they are excluded for concomitant MitraClip procedures. Pulling those codes without reading that note will get your claim denied.
Tricuspid procedures are almost entirely excluded. Aetna considers all of the following experimental:
| # | Excluded Procedure |
|---|---|
| 1 | Transcatheter tricuspid valve repair or replacement broadly |
| 2 | TriClip (TEER device) for tricuspid regurgitation — billed under 0569T and +0570T |
| 3 | Transcatheter tricuspid valve implantation/replacement (TTVI) under 0646T |
| 4 | Caval valve implantation for tricuspid regurgitation, including 0805T and 0806T |
| 5 | Transcatheter tricuspid valve annulus reconstruction under 0545T |
If your structural heart program has started offering tricuspid TEER or TTVI and is billing Aetna, stop and review now. None of these are covered under this coverage policy.
Two other notable exclusions:
| # | Excluded Procedure |
|---|---|
| 1 | Combined mitral valve repair with left atrial appendage occlusion (CPT 33340). Don't bundle these and expect reimbursement. |
| 2 | Galectin-3 (CPT 82777) and ST2 (CPT 83006) biomarker testing to predict MitraClip success — both explicitly not covered. |
| 3 | Trans-apical mitral valve repair approaches like the NeoChord System and Permavalve are also excluded. |
| 4 | Transcatheter mitral valve annuloplasty devices (Carillon Mitral Contour System, enCorTC) — not covered. |
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Transcatheter edge-to-edge mitral repair (MitraClip) — chronic MR, symptomatic on max therapy, not surgical candidate | Covered | 33418, 33419, 0345T | FDA-approved device required; surgery candidacy must be documented |
| Transcatheter mitral valve-in-valve replacement — failing bioprosthetic mitral valve, high surgical risk | Covered | 0483T, 0484T | STS score ≥8% 30-day mortality required; heart team including cardiac surgeon must assess |
| MitraClip — cardiogenic shock or refractory pulmonary edema with MR | Not Covered / Experimental | 33418, 33419 | R57.0, J81.0, J81.1 exclusion |
| MitraClip — rheumatic mitral valve disease | Not Covered / Experimental | 33418, 33419 | I05.x, I08.x excluded for MitraClip |
| MitraClip — active endocarditis | Not Covered / Experimental | 33418, 33419 | I33.x exclusion |
| MitraClip — surgical candidate | Not Covered | 33418, 33419 | If surgery is an option, MitraClip is not covered |
| MitraClip — hypertrophic cardiomyopathy / severe CHF (NTproBNP >10,000 pg/mL) | Not Covered / Experimental | 33418, 33419 | Clinical threshold must be documented |
| Transcatheter tricuspid valve repair (TriClip / TEER) | Not Covered / Experimental | 0569T, +0570T | Tricuspid TEER broadly excluded |
| Transcatheter tricuspid valve replacement (TTVI) | Not Covered / Experimental | 0646T | All transcatheter tricuspid replacement excluded |
| Caval valve implantation for tricuspid regurgitation | Not Covered / Experimental | 0805T, 0806T | Explicitly experimental |
| Tricuspid valve annulus reconstruction | Not Covered / Experimental | 0545T | Excluded |
| Combined mitral repair + left atrial appendage occlusion | Not Covered | 33418/33419 + 33340 | No bundled coverage |
| Trans-apical mitral valve repair (NeoChord, Permavalve) | Not Covered / Experimental | — | Approach-specific exclusion |
| Transcatheter mitral valve annuloplasty (Carillon, enCorTC) | Not Covered / Experimental | — | Device-specific exclusion |
| Galectin-3 testing to predict MitraClip success | Not Covered | 82777 | Biomarker exclusion |
| ST2 testing to predict MitraClip success | Not Covered | 83006 | Biomarker exclusion |
Aetna Percutaneous Valve Repair Billing Guidelines and Action Items 2026
These are the steps your billing and clinical teams need to take before this policy is applied to claims.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 33418 and 33419 before any new Aetna claims are submitted. Confirm every claim includes documentation that the patient was symptomatic on maximal medical therapy and was evaluated as a non-surgical candidate. Without that, you're billing into a wall. |
| 2 | Pull your 0483T and 0484T claims and check for STS score documentation. The 8% 30-day mortality threshold is a hard criterion. If the clinical note doesn't reference the STS score and the heart team's surgical risk determination — including the cardiac surgeon — request an addendum before submission. |
| 3 | Flag all tricuspid valve procedure billing immediately. CPT codes 0545T, 0569T, 0570T, 0646T, 0805T, and 0806T are all considered experimental under this policy. If your structural heart program bills Aetna for any of these, those claims will deny. Review payer mix for scheduled cases and counsel patients before procedures on likely non-coverage. |
| 4 | Remove 82777 and 83006 from any order sets or charge capture workflows tied to MitraClip cases for Aetna patients. These biomarker tests are explicitly not covered under CPB 0880. Billing them alongside a structural heart claim won't just deny the lab line — it creates documentation that could complicate the primary procedure claim. |
| 5 | Check ICD-10 code pairings on all mitral valve repair claims. The I05.x and I08.x (rheumatic) codes and I33.x (endocarditis) codes appear in Aetna's diagnosis list — but only as exclusions. Submitting 33418 or 33419 with I05.1 (rheumatic mitral insufficiency) as the primary diagnosis will trigger a denial under this policy. Same goes for I34.x codes with concomitant LAA occlusion. |
| 6 | Do not bill 33340 (LAA occlusion) in the same claim as mitral valve repair codes. Combined mitral valve repair and left atrial appendage occlusion is explicitly excluded. If both procedures occur in the same session, you need a clear strategy — talk to your compliance officer before you bill. |
| 7 | Confirm prior authorization requirements directly with Aetna for each covered code. The effective date is January 5, 2026. For any cases scheduled near or after that date, prior auth needs to be confirmed against CPB 0880 criteria, not an older version of the policy. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Percutaneous Valve Repair Under CPB 0880
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 0345T | CPT | Transcatheter mitral valve repair, percutaneous approach via the coronary sinus |
| 0483T | CPT | Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve |
| 0484T | CPT | Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve (additional) |
| 33418 | CPT | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed |
| 33419 | CPT | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed (additional) |
Not Covered / Experimental CPT Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0545T | CPT | Transcatheter tricuspid valve annulus reconstruction with implantation of adjustable annulus reconstruction device | Not covered per CPB 0880 |
| 0569T | CPT | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | Not covered per CPB 0880 |
| +0570T | CPT | Transcatheter tricuspid valve repair; each additional prosthesis during same session | Not covered per CPB 0880 |
| 0646T | CPT | Transcatheter tricuspid valve implantation/replacement (TTVI) with prosthetic valve, percutaneous approach | Not covered per CPB 0880 |
| 0805T | CPT | Transcatheter superior and inferior vena cava prosthetic valve implantation (caval valve implantation) | Not covered per CPB 0880 |
| 0806T | CPT | Caval valve implantation — open femoral vein approach | Not covered per CPB 0880 |
| 33340 | CPT | Percutaneous transcatheter closure of the left atrial appendage with endocardial implant | Not covered in combination with mitral valve repair |
| 82777 | CPT | Galectin-3 | Not covered as predictor for MitraClip success |
| 83006 | CPT | Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) | Not covered as predictor for MitraClip success |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| I01.1 | Acute rheumatic endocarditis |
| I05.0 | Rheumatic mitral stenosis |
| I05.1 | Rheumatic mitral insufficiency |
| I05.2 | Rheumatic mitral stenosis with insufficiency |
| I08.0 | Rheumatic disorders of both mitral and aortic valves |
| I08.1 | Rheumatic disorders of both mitral and tricuspid valves |
| I08.3 | Combined rheumatic disorders of mitral, aortic, and tricuspid valves |
| I33.0 | Acute and subacute endocarditis |
| I33.1 | Acute and subacute endocarditis |
| I33.2 | Acute and subacute endocarditis |
| I33.3 | Acute and subacute endocarditis |
| I33.4 | Acute and subacute endocarditis |
| I33.5 | Acute and subacute endocarditis |
| I33.6 | Acute and subacute endocarditis |
| I33.7 | Acute and subacute endocarditis |
| I33.8 | Acute and subacute endocarditis |
| I33.9 | Acute and subacute endocarditis |
| I34.0 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.1 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.2 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.3 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.4 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.5 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.6 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.7 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.8 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I34.9 | Mitral valve disorders — note: not covered for concomitant LAA occlusion |
| I36.1 | Nonrheumatic tricuspid valve insufficiency |
| I38 | Endocarditis, valve unspecified |
| I50.1 | Heart failure |
| I50.2 | Heart failure |
| I50.3 | Heart failure |
| I50.4 | Heart failure |
| I50.5 | Heart failure |
| I50.6 | Heart failure |
| I50.7 | Heart failure |
| I50.8 | Heart failure |
| I50.9 | Heart failure |
| J81.0 | Pulmonary edema (refractory) |
| J81.1 | Pulmonary edema (refractory) |
| R57.0 | Cardiogenic shock |
| T82.857A–T82.857S | Stenosis of other cardiac prosthetic devices, implants, and grafts |
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