TL;DR: Cigna Healthcare modified MM 0501 — its transcatheter heart valve procedures coverage policy — effective December 16, 2025. Here's what changes for billing teams.
Cigna Healthcare updated MM 0501, clarifying coverage positions for transcatheter valve procedures across aortic, mitral, pulmonary, and tricuspid approaches. The policy covers TAVR/TAVI under CPT codes 33361–33366, mitral valve repair under CPT 33418, and transcatheter mitral valve implantation/replacement via percutaneous approach under CPT 0483T — all when applicable criteria are met. It classifies transcatheter mitral valve replacement via transthoracic exposure (CPT 0484T) and all transcatheter tricuspid procedures (CPT 0569T and 0646T) as experimental and investigational. If your team bills any of these twelve codes for Cigna members, this policy change deserves your attention before December 16, 2025.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Transcatheter Heart Valve Procedures |
| Policy Code | MM 0501 |
| Change Type | Modified |
| Effective Date | December 16, 2025 |
| Impact Level | High |
| Specialties Affected | Interventional Cardiology, Cardiac Surgery, Structural Heart Programs, Hospital Outpatient |
| Key Action | Audit your charge capture for CPT 0484T, 0569T, and 0646T — billing these for Cigna members will trigger claim denial as experimental/investigational |
Cigna Transcatheter Heart Valve Coverage Criteria and Medical Necessity Requirements 2025
The Cigna transcatheter heart valve coverage policy under MM 0501 splits these procedures into two clear camps: medically necessary when criteria are met, and experimental. Knowing which codes land in which camp is the difference between clean claims and write-offs.
For TAVR/TAVI — transcatheter aortic valve replacement — Cigna considers CPT codes 33361, 33362, 33363, 33364, 33365, and 33366 medically necessary when the patient meets the applicable selection criteria. Each of those six codes reflects a different access approach: percutaneous femoral, open femoral, open axillary, open iliac, transaortic, and transapical. The clinical approach doesn't change the coverage category, but it does determine which code you bill. Getting that wrong is a common claim denial trigger.
CPT 33418 — percutaneous mitral valve repair, including transseptal puncture — also sits in the medically necessary category when criteria are met.
CPT 0483T covers transcatheter mitral valve implantation/replacement (TMVI) via percutaneous approach. Cigna classifies this as medically necessary when criteria in the applicable coverage position are met. This distinction matters. TMVI (0483T) is covered with criteria; transcatheter mitral valve replacement via transthoracic exposure (0484T) is not. If your team is billing 0484T, stop. Cigna considers it experimental.
Cigna Transcatheter Heart Valve Exclusions and Non-Covered Indications
Four codes in this policy are explicitly classified as experimental, investigational, and unproven. Cigna will not reimburse these. Bill them and you'll get a denial.
CPT 0484T — TMVI with prosthetic valve via transthoracic exposure — is experimental/investigational/unproven per MM 0501.
CPT 0569T — transcatheter tricuspid valve repair, percutaneous approach, initial prosthesis — is experimental/investigational/unproven per MM 0501.
CPT 0646T — transcatheter tricuspid valve implantation/replacement with prosthetic valve, percutaneous approach — is also experimental/investigational/unproven per MM 0501.
There's also a code listed in the policy data that appears to be a corrupted or non-standard entry — the "20549 low surgical risk patients" text — rather than a standard CPT code. It is grouped under experimental/investigational in the source data. It is not a valid billable CPT code. Don't attempt to bill it. If you see this in your charge master, flag it for your compliance officer immediately.
The real issue here is that the tricuspid valve space is moving fast clinically. But Cigna's coverage policy classifies all transcatheter tricuspid procedures as experimental. That gap between clinical adoption and coverage policy is where you lose money if you're not watching.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Transcatheter aortic valve replacement (TAVR/TAVI) — percutaneous femoral | Covered (criteria required) | 33361 | Verify PA requirements directly with Cigna |
| Transcatheter aortic valve replacement (TAVR/TAVI) — open femoral | Covered (criteria required) | 33362 | Verify PA requirements directly with Cigna |
| Transcatheter aortic valve replacement (TAVR/TAVI) — open axillary | Covered (criteria required) | 33363 | Verify PA requirements directly with Cigna |
| Transcatheter aortic valve replacement (TAVR/TAVI) — open iliac | Covered (criteria required) | 33364 | Verify PA requirements directly with Cigna |
| Transcatheter aortic valve replacement (TAVR/TAVI) — transaortic | Covered (criteria required) | 33365 | Verify PA requirements directly with Cigna |
| Transcatheter aortic valve replacement (TAVR/TAVI) — transapical | Covered (criteria required) | 33366 | Verify PA requirements directly with Cigna |
| Percutaneous mitral valve repair | Covered (criteria required) | 33418 | Includes transseptal puncture when performed |
| Transcatheter mitral valve implantation/replacement — percutaneous | Covered (criteria required) | 0483T | Confirm patient meets applicable selection criteria |
| Transcatheter mitral valve implantation/replacement — transthoracic | Experimental / Not Covered | 0484T | Cigna considers this investigational/unproven |
| Transcatheter tricuspid valve repair — percutaneous, initial prosthesis | Experimental / Not Covered | 0569T | Cigna considers this investigational/unproven |
| Transcatheter tricuspid valve implantation/replacement — percutaneous | Experimental / Not Covered | 0646T | Cigna considers this investigational/unproven |
Cigna Transcatheter Heart Valve Billing Guidelines and Action Items 2025
These are the steps your billing team and revenue cycle leadership should take before December 16, 2025.
| # | Action Item |
|---|---|
| 1 | Pull every open Cigna claim that includes CPT 0484T, 0569T, or 0646T. These are your highest denial risk codes under the updated policy. Any claim hitting Cigna's adjudication system after December 16, 2025 for these codes will likely be denied as experimental. Submit or resolve open claims before the effective date. |
| 2 | Audit your charge capture templates for structural heart programs. If your cardiac cath lab or structural heart team uses a standard charge capture set, confirm that 0484T and the tricuspid codes (0569T, 0646T) are either removed or flagged with a coverage warning for Cigna. A charge capture that auto-populates the wrong code is a systematic denial problem, not a one-off. |
| 3 | Verify prior authorization requirements directly with Cigna. The MM 0501 source policy does not specify prior authorization requirements. Contact Cigna or check their portal to confirm PA requirements for each TAVR access approach and each covered mitral procedure before billing. |
| 4 | Confirm medical necessity documentation for CPT 33418 and 0483T. Both codes are covered when criteria are met. "When criteria are met" means Cigna can deny on medical necessity grounds if documentation is thin. Your clinical team needs to document why the patient qualifies — not just that the procedure was performed. Review what criteria Cigna specifies in the full MM 0501 policy text and make sure your notes map to those criteria directly. |
| 5 | Flag 0483T vs. 0484T confusion in your CDM. These two codes are easy to mix up. Both describe TMVI, but 0483T is percutaneous (covered with criteria) and 0484T is transthoracic (experimental, not covered). This is exactly the kind of single-digit code difference that generates silent denials. Run a crosswalk on your charge description master (CDM) now. |
| 6 | Talk to your compliance officer if you have any active Cigna contracts that include tricuspid valve programs. If your hospital or practice is billing Cigna for tricuspid procedures under 0569T or 0646T — especially if you've been doing so in anticipation of coverage expansion — you need a compliance review before December 16, 2025. The financial exposure on experimental denials with recoupment risk is real. |
| 7 | Set a calendar alert to revisit this policy in mid-2026. The tricuspid valve device market is moving fast. Cigna's experimental designation on 0569T and 0646T reflects their current coverage position under MM 0501. Watch for updates as the policy is revised. |
| 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 Transcatheter Heart Valve Procedures Under MM 0501
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 33361 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach |
| 33362 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach |
| 33363 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach |
| 33364 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach |
| 33365 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach |
| 33366 | CPT | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure |
| 33418 | CPT | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed |
| 0483T | CPT | Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; percutaneous approach |
Not Covered / Experimental Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| 0484T | CPT | Transcatheter mitral valve implantation/replacement (TMVI) with prosthetic valve; transthoracic exposure | Considered Experimental/Investigational/Unproven |
| 0569T | CPT | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | Considered Experimental/Investigational/Unproven |
| 0646T | CPT | Transcatheter tricuspid valve implantation/replacement with prosthetic valve, percutaneous approach | Considered Experimental/Investigational/Unproven |
| "20549..." | N/A | Entry appears in source policy data as experimental/investigational but is not a valid billable CPT code — likely corrupted or non-standard data | Do not bill. Flag in your charge master and escalate to your compliance officer. |
Note on ICD-10 codes: The MM 0501 policy data does not list specific ICD-10-CM diagnosis codes. Work with your clinical documentation team to confirm that the primary diagnosis codes on TAVR, TMVI, and mitral repair claims align with the applicable medical necessity criteria Cigna specifies in the full policy. Aortic stenosis, mitral regurgitation, and related structural heart diagnoses are the expected primary diagnoses — but Cigna's criteria language governs what's actually required.
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