Cardiac Resynchronization Therapy (CRT) - (0174) — MM 0174 | CIGNA Coverage Update

Cigna modified MM 0174 for cardiac resynchronization therapy (CRT), effective December 16, 2025. Here's what changes for billing teams.

Cigna Healthcare updated its coverage policy for biventricular pacing and CRT under policy code MM 0174 in its coverage position criteria system. This policy governs reimbursement for CRT devices—including biventricular pacemakers used alone or combined with an implantable cardioverter defibrillator (ICD)—as well as triple-site pacing and conduction system pacing for CRT. The primary CPT codes affected include 33224 and 33249. If your practice bills for cardiac device implantation in Cigna patients, audit your charge capture and documentation before December 16, 2025.

Quick-Reference Table

Cigna Cardiac Resynchronization Therapy Coverage Criteria and Medical Necessity Requirements 2025

The Cigna CRT coverage policy under MM 0174 covers three distinct device categories. Each has its own medical necessity criteria. Knowing which bucket your patient falls into determines whether your claim pays or denies.

Biventricular Pacemaker (CRT-P): This is the foundational indication under this policy. Coverage applies when medical necessity criteria are met. The policy covers biventricular pacemakers used as standalone devices. This applies to patients with chronic heart failure and ventricular dyssynchrony who meet the specified clinical thresholds.

CRT-D (Biventricular Pacemaker with ICD): Cigna covers the combination device—biventricular pacemaker plus implantable cardioverter defibrillator—when criteria in the applicable coverage section are satisfied. CPT 33249 is the primary code for ICD system insertion or replacement with transvenous leads, and this code falls under the "considered medically necessary when criteria are met" designation.

Triple-Site or Triventricular Pacing CRT: This is where the policy gets more restrictive. Triple-site pacing adds a third pacing lead beyond the standard biventricular configuration. Cigna's coverage position on this modality is addressed separately within MM 0174, and it carries a higher documentation burden.

Conduction System Pacing for CRT: His bundle pacing and left bundle branch area pacing as CRT alternatives are explicitly addressed in this policy revision. This is a newer clinical approach, and payers have been inconsistent about coverage. Cigna's position under MM 0174 now formally addresses this category—which is the most significant element of this modification for billing teams.

The Cigna cardiac resynchronization therapy coverage policy requires that claims for CPT 33224—insertion of a pacing electrode into the cardiac venous system for left ventricular pacing—meet the applicable medical necessity criteria before submission. Document the ejection fraction, QRS duration, NYHA functional class, and prior optimal medical therapy clearly in the record. Cigna will look for all of it.

Prior authorization is standard for these procedures. Confirm your prior authorization workflow includes the updated criteria under MM 0174 before your team submits auth requests for procedures scheduled after December 16, 2025. Missing a revised criterion on the front end means a denial on the back end—and CRT device claims carry significant dollar exposure per encounter.

Cigna CRT Exclusions and Non-Covered Indications

The policy does not limit its scope to straightforward biventricular pacing. Two categories warrant close attention as potential non-covered or experimental designations.

Triple-site pacing involves stimulating three cardiac sites simultaneously. This approach is used when standard biventricular CRT produces a suboptimal response. Whether Cigna covers this under MM 0174 or classifies it as investigational depends on the specific clinical indication and supporting evidence documented in the record. Treat this as a coverage policy risk area until you have reviewed the full MM 0174 document.

Conduction system pacing for CRT—including His bundle pacing and left bundle branch area (LBBA) pacing—is increasingly used as an alternative to traditional transvenous CRT. Cigna's coverage position on this approach has been evolving. The December 16, 2025 modification specifically addresses this category. If your electrophysiologists have shifted toward conduction system pacing as their preferred CRT technique, verify your Cigna claim denial rate on these cases now, before the effective date locks in the updated criteria.

If your practice does a meaningful volume of non-traditional CRT approaches, loop in your compliance officer before December 16, 2025. The line between "considered medically necessary when criteria are met" and "investigational" can shift between policy versions—and with devices at this price point, one miscategorized procedure can create serious reimbursement exposure.

Coverage Indications at a Glance

Cigna Cardiac Resynchronization Therapy Billing Guidelines and Action Items 2025

These are the steps your billing team and RCM leadership should take before December 16, 2025.

CPT, HCPCS, and ICD-10 Codes for Cardiac Resynchronization Therapy Under MM 0174

The policy data includes two confirmed CPT codes under the "considered medically necessary when criteria are met" designation. Note that the policy source data contains one apparent formatting artifact in the code table—a citation string that does not represent a valid CPT code. That entry is excluded below.

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Both codes carry the same coverage designation: considered medically necessary when criteria in the applicable coverage position criteria are met. That phrase means the claim does not pay on code alone—the clinical record must support the indication.

A Note on the Policy Code Data

The raw policy data includes what appears to be a bibliographic citation string ("2019b Jul 9;74(1 1) 5: 9 1 . 57-") in the CPT code field. This is not a valid CPT or HCPCS code. It is likely a reference to a clinical guideline or publication embedded in the policy source. Do not bill this string. If you are auditing MM 0174 claims and see this artifact in your source documentation, it has no billing relevance.

ICD-10-CM Diagnosis Codes

No ICD-10-CM codes were listed in the available MM 0174 policy data. For diagnosis coding on CRT claims, your team should use the patient's specific heart failure diagnosis codes (typically from the I50.x family) paired with the appropriate ventricular dyssynchrony or conduction abnormality codes. Confirm the required ICD-10 codes with the full policy document or your MAC's local coverage determination guidance.