Transcatheter Closure of Cardiovascular Defects - (0011) — MM 0011 | CIGNA Coverage Update

Cigna modified MM 0011 for transcatheter closure of cardiovascular defects, effective November 15, 2025. Here's what billing teams need to know before claims go out the door.

Cigna Healthcare updated coverage position criteria under MM 0011 in the Cigna system, covering transcatheter and perventricular approaches to closing secundum atrial septal defects (ASD), patent ductus arteriosus (PDA), patent foramen ovale (PFO), ventricular septal defects (VSD), and related cardiovascular structural defects. The two codes directly named in this policy — CPT 33999 and CPT 93799 — are both classified as Experimental/Investigational/Unproven for specific indications. If your cardiology or cardiovascular surgery program bills either of those unlisted codes, this update has real claim denial exposure.

Quick-Reference Table

Cigna Transcatheter Cardiovascular Closure Coverage Criteria and Medical Necessity Requirements 2025

The Cigna transcatheter closure of cardiovascular defects coverage policy — MM 0011 — addresses a wide range of structural heart conditions. It covers neonates, infants, children, and adults, so this isn't just a pediatric cardiology issue. Your adult structural heart program is equally exposed.

The procedures addressed under this policy include:

The policy uses cardiac occlusion devices as the mechanism across these indications. Medical necessity determinations under this coverage policy will hinge on which specific defect type you're treating and how the claim is coded.

The real issue here is what falls outside covered status. Two of the most commonly used unlisted codes in cardiovascular surgery — CPT 33999 and CPT 93799 — are explicitly classified as Experimental/Investigational/Unproven for specific indications under this policy. That classification directly blocks reimbursement for those indications. The full qualifying language that defines which indications trigger E/I/U status is available in the complete MM 0011 policy text. Review it before billing either code.

Before your team submits any claim involving these procedures, confirm the specific defect type and approach against the full policy. Medical necessity documentation needs to be airtight — the diagnosis, the anatomical defect, the approach, and the device used all need to tell a consistent story.

For high-cost structural heart procedures like these, follow your standard prior authorization process. Check your Cigna contract and plan-level benefits before the November 15, 2025 effective date.

Cigna Transcatheter Closure Exclusions and Non-Covered Indications

This is where MM 0011 does the most damage to revenue cycle teams that aren't paying attention.

CPT 33999 (Unlisted procedure, cardiac surgery) and CPT 93799 (Unlisted cardiovascular service or procedure) are both flagged as Experimental/Investigational/Unproven for specific indications under this policy. Claims for services designated as Experimental/Investigational/Unproven are generally not covered under Cigna policies. Consult the full policy text for the specific qualifying indications.

Unlisted codes are already high-risk for claim denial under any payer — they require manual review, detailed documentation, and a clear rationale for why no specific CPT code exists. Under MM 0011, that risk is compounded because Cigna has stated explicitly that certain uses of these codes fall into the Experimental/Investigational/Unproven bucket.

The policy does not spell out in the available summary language exactly which indications trigger the E/I/U classification for each unlisted code. That ambiguity is real, and it's not your team's fault. Talk to your compliance officer before the November 15, 2025 effective date if you routinely bill either of these codes for structural heart closure procedures.

Coverage Indications at a Glance

Cigna Transcatheter Cardiovascular Defect Billing Guidelines and Action Items 2025

Cigna transcatheter closure billing requires a tighter pre-claim workflow than most cardiovascular procedures. Here's what to do before and after November 15, 2025.

CPT, HCPCS, and ICD-10 Codes for Transcatheter Cardiovascular Closure Under MM 0011

The policy data for MM 0011 includes two CPT codes. Both are unlisted codes, and both carry an Experimental/Investigational/Unproven designation for specific indications. No HCPCS Level II codes and no ICD-10-CM codes are listed in the policy data for this coverage position.

Not Covered / Experimental Codes (When Used for Specific Indications)

No ICD-10-CM codes are listed in the MM 0011 policy data. Standard diagnosis coding guidelines apply. Consult your coding resources for appropriate diagnosis codes for each structural heart defect type you bill. The absence of ICD-10 codes in this policy doesn't reduce your documentation obligation — it increases it.