Cigna modified MM 0054 for ventricular assist devices, percutaneous cardiac support systems, and total artificial heart coverage, effective December 16, 2025. Here's what billing teams need to act on now.
Cigna Healthcare updated Coverage Policy MM 0054 governing mechanical circulatory assist devices. The policy covers ventricular assist devices (VADs), percutaneous VADs (pVADs), permanently implantable aortic counterpulsation VADs, and the total artificial heart (TAH). Twelve CPT codes and one HCPCS code are in scope — from CPT 33927 and 33928 for total artificial heart implantation and replacement, to CPT 33990 and 33991 for percutaneous VAD insertion. If your facility or practice bills for any of these devices under Cigna, this policy change needs your attention before December 16, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Ventricular Assist Devices (VADs), Percutaneous Cardiac Support Systems and Total Artificial Heart |
| Policy Code | MM 0054 |
| Change Type | Modified |
| Effective Date | December 16, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiac surgery, interventional cardiology, cardiovascular surgery, advanced heart failure programs |
| Key Action | Audit charge capture for CPT 33927, 33975, 33979, 33990, and HCPCS E1399 against updated medical necessity criteria before December 16, 2025 |
Cigna VAD and Total Artificial Heart Coverage Criteria and Medical Necessity Requirements 2025
The Cigna VAD coverage policy under MM 0054 in the Cigna system draws clear lines between what's medically necessary and what's experimental. Most of the 12 CPT codes in this policy land on the covered side — but only when specific selection criteria are met.
CPT codes 33927 and 33928 — implantation and removal/replacement of a total artificial heart system — are covered when criteria in the applicable coverage policy sections are satisfied. The same applies to CPT 33975 and 33976 for extracorporeal VAD insertion (single and biventricular), CPT 33979 for implantable intracorporeal single-ventricle VAD insertion, and CPT 33981 for replacement of extracorporeal VAD pumps.
Pump replacement codes CPT 33982 and 33983 — covering implantable intracorporeal single-ventricle devices with and without cardiopulmonary bypass — are also covered under the same framework. Percutaneous VAD codes CPT 33990, 33991, and repositioning code CPT 33993 fall into the medically necessary category when criteria are met. HCPCS E1399 (durable medical equipment, miscellaneous) is covered specifically when used to report the SynCardia temporary Total Artificial Heart — that's a narrow, device-specific coverage position that your billing team needs to know by name.
This is a high-stakes coverage policy. These procedures carry significant reimbursement value, and claim denial for failing to document medical necessity on a VAD or TAH case is an expensive problem. Prior authorization requirements for these procedures are standard with Cigna — verify current prior auth requirements with your Cigna provider rep before December 16, 2025.
Cigna VAD and Artificial Heart Exclusions and Non-Covered Indications
One code in MM 0054 sits firmly in the experimental/investigational/unproven category: CPT 33999, the unlisted cardiac surgery procedure code.
This is worth flagging loudly. CPT 33999 is a catch-all code that some teams use when no other code cleanly fits a novel or off-label cardiac surgery. Under this Cigna coverage policy, billing 33999 in the context of VAD or TAH procedures will get you denied. If you're performing a device-related procedure that your team is tempted to capture with 33999, stop and consult your billing consultant or medical director before submitting. The policy is explicit: this code is not covered in this clinical context.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Total artificial heart implantation | Covered | CPT 33927 | Criteria must be met per MM 0054 |
| Total artificial heart removal and replacement | Covered | CPT 33928 | Criteria must be met per MM 0054 |
| Extracorporeal VAD insertion, single ventricle | Covered | CPT 33975 | Criteria must be met |
| Extracorporeal VAD insertion, biventricular | Covered | CPT 33976 | Criteria must be met |
| Implantable intracorporeal VAD insertion, single ventricle | Covered | CPT 33979 | Criteria must be met |
| Extracorporeal VAD pump replacement, single or biventricular | Covered | CPT 33981 | Criteria must be met |
| Implantable intracorporeal VAD pump replacement, without CPB | Covered | CPT 33982 | Criteria must be met |
| Implantable intracorporeal VAD pump replacement, with CPB | Covered | CPT 33983 | Criteria must be met |
| Percutaneous VAD insertion, left heart | Covered | CPT 33990 | Criteria must be met; includes radiology supervision and interpretation |
| Percutaneous VAD insertion, right heart | Covered | CPT 33991 | Criteria must be met; includes radiology supervision and interpretation |
| Percutaneous VAD repositioning with imaging guidance | Covered | CPT 33993 | Criteria must be met |
| SynCardia temporary Total Artificial Heart (DME billing) | Covered | HCPCS E1399 | Device-specific; only for SynCardia TAH |
| Unlisted cardiac surgery procedure in VAD/TAH context | Not Covered | CPT 33999 | Considered experimental/investigational/unproven |
Cigna VAD and Artificial Heart Billing Guidelines and Action Items 2025
VAD and TAH billing guidelines under MM 0054 require precision. These procedures generate high-dollar claims, and Cigna scrutinizes them. Here's what your team needs to do.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for all 13 codes in MM 0054 before December 16, 2025. Confirm that CPT 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33990, 33991, 33993, and HCPCS E1399 are mapped to current documentation requirements. Flag CPT 33999 as a non-covered code in this context and add a billing alert to prevent inadvertent submission. |
| 2 | Verify prior authorization workflows for every VAD and TAH case. Prior authorization is standard for high-cost implantable cardiac devices under Cigna. Confirm your team is submitting prior auth requests with complete clinical documentation — heart failure classification, hemodynamic data, and candidacy criteria — before scheduling. |
| 3 | Lock down your E1399 billing criteria. HCPCS E1399 is only covered when it reports the SynCardia temporary Total Artificial Heart. If your team uses E1399 as a generic DME miscellaneous code for other devices, that claim will deny. Add a charge capture rule that flags E1399 for clinical review before submission. |
| 4 | Do not use CPT 33999 for VAD or TAH procedures. Period. If a procedure doesn't fit a specific code in MM 0054, escalate to your billing consultant before submitting. Using an unlisted code in this clinical context is a denial waiting to happen under this coverage policy. |
| 5 | Confirm that percutaneous VAD claims include imaging documentation. CPT 33990 and 33991 include radiological supervision and interpretation as part of the code descriptor. Your documentation needs to reflect that imaging guidance was used. Missing imaging documentation is a common reason for claim denial on these codes. |
| 6 | Check the effective date on any claims in your queue. The effective date is December 16, 2025. Claims for dates of service on or after that date must meet updated MM 0054 criteria. If you have VAD or TAH claims pending for late December, confirm they're being held and reviewed against the updated policy. |
| 7 | If your case mix includes a high volume of VAD or TAH procedures, loop in your compliance officer. The financial exposure on a denied VAD claim is significant. A compliance review of your documentation standards against MM 0054 before the effective date is worth the time. |
| 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 Ventricular Assist Devices and Total Artificial Heart Under MM 0054
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 33927 | CPT | Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy |
| 33928 | CPT | Removal and replacement of total replacement heart system (artificial heart) |
| 33975 | CPT | Insertion of ventricular assist device; extracorporeal, single ventricle |
| 33976 | CPT | Insertion of ventricular assist device; extracorporeal, biventricular |
| 33979 | CPT | Insertion of ventricular assist device, implantable, intracorporeal, single ventricle |
| 33981 | CPT | Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or biventricular |
| 33982 | CPT | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass |
| 33983 | CPT | Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass |
| 33990 | CPT | Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; left heart |
| 33991 | CPT | Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; right heart |
| 33993 | CPT | Repositioning of percutaneous right or left heart ventricular assist device with imaging guidance at time of insertion |
Covered HCPCS Codes (Device-Specific Coverage)
| Code | Type | Description | Coverage Note |
|---|---|---|---|
| E1399 | HCPCS | Durable medical equipment, miscellaneous | Covered only when used to report the SynCardia temporary Total Artificial Heart |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 33999 | CPT | Unlisted procedure, cardiac surgery | Considered Experimental/Investigational/Unproven in the context of VAD/TAH procedures |
No ICD-10-CM diagnosis codes are listed in the MM 0054 policy data.
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