Transcatheter Heart Valve Procedures - (0501) — MM 0501 | CIGNA Coverage Update

Cigna modified MM 0501 covering transcatheter heart valve procedures, effective December 16, 2025. Here's what billing teams need to know before that date.

Cigna Healthcare updated its transcatheter heart valve coverage policy under MM 0501 to address aortic and pulmonary valve replacement, percutaneous mitral valve repair, and tricuspid valve repair or replacement. The update draws a clear line between what Cigna considers medically necessary and what it classifies as experimental — and that line runs directly through several high-dollar CPT codes your team may already be billing. The primary codes affected include 33361 through 33366 for TAVR/TAVI, 33418 for percutaneous mitral valve repair, 0483T for transcatheter mitral valve implantation, and 0484T, 0569T, and 0646T, which remain in experimental territory.

Quick-Reference Table

Cigna Transcatheter Heart Valve Coverage Criteria and Medical Necessity Requirements 2025

The Cigna transcatheter heart valve coverage policy under MM 0501 covers two distinct clinical pathways: transcatheter aortic valve replacement (TAVR/TAVI) and percutaneous mitral valve repair. Each has its own medical necessity criteria, and failing to document against those criteria is the fastest way to trigger a claim denial.

For TAVR/TAVI, Cigna considers CPT codes 33361, 33362, 33363, 33364, 33365, and 33366 medically necessary when patients meet defined selection criteria. These six codes cover every approved access route — percutaneous femoral, open femoral, open axillary, open iliac, transaortic, and transapical. The access approach does not change the coverage threshold. Medical necessity does.

For percutaneous mitral valve repair, CPT 33418 is considered medically necessary when the applicable criteria are met. CPT 0483T — transcatheter mitral valve implantation or replacement via percutaneous approach — also falls under the medically necessary category, but with its own criteria. Do not conflate repair (33418) with replacement (0483T) in your documentation or prior authorization requests. Cigna treats them differently, and your supporting documentation should too.

Prior authorization almost certainly applies to these procedures given their complexity and dollar value. Confirm with Cigna directly for each patient and plan type — commercial, Medicare Advantage, and managed Medicaid may have different prior auth workflows under MM 0501. Missing prior authorization on a TAVR claim is not a correctable error after the fact.

Reimbursement for these procedures is substantial, which is exactly why Cigna scrutinizes them closely. Underdocumented claims for 33361–33366 or 33418 will face denial or downcoding. Your clinical documentation should map directly to the medical necessity criteria in MM 0501 before the claim ever leaves your system.

Cigna Transcatheter Heart Valve Exclusions and Non-Covered Indications

Three codes remain firmly in experimental and investigational status under this coverage policy. Cigna will not reimburse claims for these procedures under MM 0501, and no amount of additional documentation changes that classification.

CPT 0484T — Transcatheter mitral valve implantation or replacement with prosthetic valve via transthoracic exposure — is considered experimental and investigational. This is a different access approach from 0483T, and the transthoracic route does not currently meet Cigna's coverage threshold.

CPT 0569T — Transcatheter tricuspid valve repair, percutaneous approach, initial prosthesis — is experimental. Cigna does not cover percutaneous tricuspid valve repair under MM 0501.

CPT 0646T — Transcatheter tricuspid valve implantation or replacement with prosthetic valve, percutaneous approach — is also experimental. Transcatheter tricuspid interventions, whether repair or replacement, sit outside Cigna's covered indications at this time.

The real risk here is upcoding or miscoding between covered and non-covered procedures. A transcatheter mitral valve repair (33418, covered) and a transcatheter mitral valve replacement via transthoracic access (0484T, experimental) are not interchangeable. If your clinical team performs a procedure that maps to an experimental code, bill that code — and counsel the facility on the financial exposure before the case.

There is also a data artifact in the policy code table worth flagging. A row referencing "20549 low surgical risk patients" appears in the experimental group with no valid CPT code attached. This looks like a documentation error in the source policy — likely a fragment of clinical study data embedded in the wrong field. Do not bill this as a code. Flag it with your billing consultant if it surfaces in your charge capture workflow.

Coverage Indications at a Glance

Cigna Transcatheter Heart Valve Billing Guidelines and Action Items 2025

The effective date of December 16, 2025 is your deadline. Work backward from it.

If you are unsure how MM 0501 applies to your specific payer mix — especially if you have significant Cigna Medicare Advantage volume — talk to your billing consultant before December 16, 2025.

CPT, HCPCS, and ICD-10 Codes for Transcatheter Heart Valve Procedures Under MM 0501

Covered CPT Codes (When Medical Necessity Criteria Are Met)

Experimental / Investigational / Non-Covered CPT Codes

Note: The policy source data includes an anomalous row referencing "20549 low surgical risk patients" in the experimental group. This does not correspond to a valid CPT code and appears to be a data error in the source document. Do not bill it. Flag it with your billing consultant if it appears in your systems.

No ICD-10-CM codes are listed in the MM 0501 policy data.