Leadless Cardiac Pacemaker — CPB 0893 | AETNA Coverage Update

Aetna modified CPB 0893 for leadless cardiac pacemakers, effective January 5, 2026. Here's what billing teams need to know before submitting claims.

Aetna, a CVS Health company, updated its leadless cardiac pacemaker coverage policy under CPB 0893 in the Aetna system, narrowing medical necessity criteria to a strict two-part test. The policy covers devices like the Micra and Aveir Transcatheter Pacing Systems, and it affects a substantial code set — including CPT 33274, 33275, 0795T through 0804T, 0823T through 0826T, HCPCS C1605, and C1740. If your practice implants or manages leadless pacemakers for Aetna members, this coverage policy change has direct claim denial and reimbursement implications starting now.

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Quick Reference: Aetna CPB 0893 Leadless Cardiac Pacemaker Policy (2026)

Field	Detail
Payer	Aetna, a CVS Health company
Policy	Leadless Cardiac Pacemaker
Policy Code	CPB 0893
Change Type	Modified
Effective Date	January 5, 2026
Impact Level	High
Specialties Affected	Electrophysiology, Cardiology, Cardiac Surgery, Cardiac Device Management
Key Action	Confirm both medical necessity criteria and contraindication documentation are in the chart before billing CPT 33274, 0795T, or 0823T

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Aetna Leadless Cardiac Pacemaker Coverage Criteria and Medical Necessity Requirements 2026

The real issue with this coverage policy is the AND logic. Both criteria must be met. Miss either one, and you're looking at a denial.

Criterion 1 — Qualifying cardiac condition. The member must have one of the following symptomatic diagnoses:

#	Covered Indication Copy
1	Symptomatic paroxysmal or permanent high-grade atrioventricular (AV) block
2	Symptomatic bradycardia-tachycardia syndrome
3	Sinus node dysfunction — specifically sinus bradycardia or sinus pauses

ICD-10 codes I44.0 through I44.9 (and the full I44.x subcategory tree) map to the AV block indications. Cardiac dysrhythmias in the I47.0–I49.49 range and paroxysmal atrial fibrillation (I48.0) also appear on the covered diagnosis list. Your ICD-10 selection must be precise. "Symptomatic" matters here — a documented AV block without clinical symptoms doesn't satisfy this criterion.

Criterion 2 — Significant contraindication to conventional lead placement. The member must have at least one of the following:

#	Covered Indication Copy
1	History of an endovascular or cardiovascular implantable electronic device (CIED) infection, OR high risk for infection
2	Limited venous access — including venous anomaly, axillary vein occlusion, planned use of axillary veins for a semi-permanent catheter, or current/planned AV fistula for hemodialysis
3	A bioprosthetic tricuspid valve

This is where most claims will get kicked. Aetna is not covering leadless pacemakers as a routine alternative to conventional devices. The contraindication must be documented clearly in the medical record. Vague language like "poor candidate for traditional pacing" won't hold up on appeal.

Prior authorization requirements are not explicitly stated within this version of the policy, but given the high-cost nature of these procedures, check Aetna's precertification list before scheduling. The prior auth requirement for implantable cardiac devices varies by plan. Confirm at the plan level before you book the case.

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Aetna Leadless Cardiac Pacemaker Exclusions and Non-Covered Indications

Aetna draws hard lines on three categories. Bill outside these, and you'll get denied — not delayed, denied.

All other indications. If the member's diagnosis doesn't fit the two-part test above, Aetna classifies the procedure as experimental, investigational, or unproven. The policy language is explicit: "safety and/or effectiveness for other indications has not been established." That's a blanket exclusion for off-label use.

Leadless pacemaker combined with cardiac resynchronization therapy (CRT). Aetna does not cover this combination for enhancement of synchronized pacing capabilities. CPT 93319, which covers 3D echocardiographic imaging during transesophageal echo for this purpose, is specifically grouped under the experimental category in this policy. If your electrophysiologist is pursuing a leadless + CRT approach, this is not a covered service under Aetna CPB 0893.

Leadless pacemaker combined with subcutaneous implantable cardioverter-defibrillator (S-ICD). Aetna considers this combination for prevention of sudden cardiac death experimental and unproven. Related codes — including conventional ICD insertion codes like CPT 33249, 33240, 33230, 33231, and removal/replacement codes 33262 through 33264 — appear in the "other related codes" section. They are not covered when used in combination with a leadless pacemaker outside of the approved indications.

These exclusions matter for bundling decisions, too. If you're billing a leadless device insertion alongside CRT or S-ICD components, expect Aetna to flag the claim.

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Coverage Indications at a Glance

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Aetna Leadless Cardiac Pacemaker Billing Guidelines and Action Items 2026

This is where the policy change turns into real work for your team. These steps apply immediately — the effective date is January 5, 2026, which means claims already in your queue need a review.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Leadless Cardiac Pacemakers Under CPB 0893

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
C1605	HCPCS	Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive
C1740	HCPCS	Leadless electrode, transmitter, battery (all implantable), for sequential left ventricular pacing

Not Covered / Experimental CPT Codes

Code	Type	Description	Reason Copy
93319	CPT	3D echocardiographic imaging and postprocessing during transesophageal echocardiography	Grouped under leadless pacemaker + CRT combination — experimental

Key ICD-10-CM Diagnosis Codes

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