TL;DR: UnitedHealthcare modified its cardiovascular diagnostic and therapeutic procedures coverage policy (cardiovascular-diagnostic-procedures) effective February 2, 2026. Here's what billing teams need to act on now.
This update to the UnitedHealthcare Medicare Advantage Medical Policy touches multiple high-volume cardiovascular service lines — catheter ablation (CPT 93653, 93656), lower extremity endovascular revascularization (CPT 37230–37298), implantable pulmonary artery pressure sensors (CPT 33289, 93264, HCPCS C2624), and transcatheter pulmonary valve replacement (CPT 33477). The policy consolidates coverage guidance across NCD, LCD, and commercial policy references. If your practice bills any of these codes for Medicare Advantage patients, this update changes where you look for medical necessity criteria and prior authorization requirements.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | UnitedHealthcare |
| Policy | Cardiovascular Diagnostic and Therapeutic Procedures – Medicare Advantage Medical Policy |
| Policy Code | cardiovascular-diagnostic-procedures |
| Change Type | Modified |
| Effective Date | February 2, 2026 |
| Impact Level | High |
| Specialties Affected | Cardiology, Vascular Surgery, Electrophysiology, Interventional Cardiology, Cardiac Surgery |
| Key Action | Audit charge capture and prior auth workflows for CPT 33289, 93264, 93653, 93656, 33477, and 37230–37298 before scheduling procedures under the updated policy |
UnitedHealthcare Cardiovascular Procedure Coverage Criteria and Medical Necessity Requirements 2026
The cardiovascular-diagnostic-procedures UnitedHealthcare system policy is not a single set of rules. It's a routing document. For most service lines covered here, UHC directs you to a separate coverage policy — either an NCD, an LCD, or a UHC Commercial Medical Policy — depending on what procedure you're billing and what state you're in.
That layered structure is worth understanding before you do anything else. Where you find the actual medical necessity criteria depends on the specific procedure. Get that wrong, and you're submitting claims against the wrong criteria set.
Arterial Compliance Testing (CPT 93050)
Medicare has no National Coverage Determination for arterial compliance testing using waveform analysis. No LCDs or local coverage articles exist either. For medical necessity criteria on CPT 93050, UHC routes Medicare Advantage billing to the UnitedHealthcare Commercial Medical Policy titled Cardiovascular Disease Risk Tests. That's the document your billing team and clinical staff need to review before submitting claims.
Cardiac CT and CCTA
Cardiac computed tomography and coronary CT angiography coverage questions get handled under a different policy entirely — the UHC Medicare Advantage Medical Policy titled Radiologic Diagnostic Procedures. The cardiovascular-diagnostic-procedures policy does not set the criteria here. If your team bills CCTA and is using this policy as your reference, stop. Go to the Radiology policy instead.
Catheter Ablation (CPT 93653, 93656)
For atrial fibrillation treatment, Medicare has no NCD and no applicable LCDs. UHC routes coverage questions to the UnitedHealthcare Commercial Medical Policy titled Catheter Ablation for Atrial Fibrillation. CPT 93653 and 93656 are the primary codes here — both involve comprehensive electrophysiologic evaluation with catheter ablation.
For other arrhythmias like atrial flutter, the reference is different. UHC uses the InterQual® CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac criteria. This is a separate document from the commercial policy. Your clinical team needs access to InterQual to verify medical necessity for these cases.
Lower Extremity Endovascular Revascularization (CPT 37230–37298)
This is the most complex section in the policy, and it has the most exposure for claim denial.
Medicare has an NCD covering percutaneous transluminal angioplasty (PTA) without stenting or atherectomy on iliac, femoral, and popliteal arteries. That's NCD 20.7. Reference it for PTA-only procedures.
For PTA with stenting and/or atherectomy, there's no NCD — but LCDs exist. UHC requires compliance with those LCDs where they apply. The policy includes a reference table for state-specific LCD assignments. If you're in a state with no LCD, UHC uses the UnitedHealthcare Commercial Medical Policy titled Lower Extremity Endovascular Procedures as the fallback.
Open endovascular procedures (with or without stenting, atherectomy, or angioplasty) have no NCD and no LCDs. Coverage defaults to the same commercial policy. Your billing team needs to know which coverage path applies based on procedure type and patient location before submitting CPT 37230 through 37298.
Implantable Pulmonary Artery Pressure Sensors (CPT 33289, 93264, HCPCS C2624)
This is the section with the most recent and highest-stakes change. CMS issued NCD 20.36 effective January 13, 2025, covering implantable pulmonary artery pressure sensors (IPAPS) — including the CardioMEMS™ HF System and Cordella™ PA Sensor System — for heart failure management.
The NCD is not a green light. NCD 20.36 says IPAPS for heart failure management is not covered outside of a CMS-approved study. That's the default. Coverage only exists through a CMS-approved Coverage with Evidence Development (CED) clinical trial, through NCD 310.1 (Clinical Trial Policy), or through an Investigational Device Exemption (IDE).
If you're billing CPT 33289 (implantation) or 93264 (remote monitoring) for a Medicare Advantage patient, the patient must be enrolled in an approved CED trial. HCPCS C2624 covers the device itself. All three codes face the same coverage restriction.
Cardiology Prior Authorization
UHC maintains prior authorization programs for cardiology imaging across some plans. Check UHCprovider.com under Cardiology Prior Authorization and Notification before scheduling. This applies regardless of the specific procedure — prior auth requirements vary by plan, and missing that step is a common source of denial.
UnitedHealthcare Cardiovascular Procedure Exclusions and Non-Covered Indications
Implantable Pulmonary Artery Pressure Sensors Outside CED Trials
Under NCD 20.36, IPAPS for heart failure management has no routine Medicare coverage. Billing CPT 33289, 93264, or HCPCS C2624 outside of an approved CMS CED study will result in denial. This applies to Medicare Advantage plans under UHC. The devices themselves — CardioMEMS and Cordella — are not covered under standard medical necessity criteria for this population.
Lower Extremity Open Endovascular Procedures
Open endovascular procedures for lower extremity revascularization have no NCD and no LCDs. Coverage defaults to the commercial policy, which means your claim needs to meet the criteria in that document. Submitting without that review is a denial waiting to happen.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Arterial compliance testing via waveform analysis | Covered per Commercial Policy | CPT 93050 | No NCD or LCD; refer to UHC Commercial Policy – Cardiovascular Disease Risk Tests |
| Cardiac CT / CCTA | Refer to Radiology Policy | Not listed in this policy | Coverage determined under UHC Medicare Advantage Radiologic Diagnostic Procedures policy |
| Catheter ablation – atrial fibrillation | Covered per Commercial Policy | CPT 93653, 93656 | No NCD or LCD; refer to UHC Commercial Policy – Catheter Ablation for Atrial Fibrillation |
| Catheter ablation – atrial flutter and other arrhythmias | Covered per InterQual | CPT 93653, 93656 | Criteria: InterQual® EP Testing +/- Catheter Ablation |
| Lower extremity PTA without stenting/atherectomy | Covered per NCD 20.7 | CPT 37254–37298 (varies by territory) | NCD exists; refer to NCD for PTA (20.7) |
| Lower extremity PTA with stenting and/or atherectomy | Covered per LCD (where applicable) | CPT 37254–37298 | LCDs required where they exist; commercial policy used in gap states |
| Lower extremity open endovascular procedures | Covered per Commercial Policy | CPT 37230–37298 | No NCD or LCD; refer to UHC Commercial Policy – Lower Extremity Endovascular Procedures |
| Implantable PA pressure sensor (IPAPS) – HF management | Not covered outside CED trial | CPT 33289, 93264; HCPCS C2624 | NCD 20.36 effective Jan. 13, 2025; must be in CMS-approved CED study |
| Transcatheter pulmonary valve replacement | Covered per separate criteria | CPT 33477 | Refer to full policy for valve-specific criteria |
UnitedHealthcare Cardiovascular Procedure Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Verify your coverage policy reference source before billing each service line. This policy routes medical necessity determinations to four different documents depending on the procedure. Confirm which policy applies — NCD, LCD, UHC Commercial Policy, or InterQual — before submitting any claim under cardiovascular-diagnostic-procedures. |
| 2 | For CPT 33289, 93264, and HCPCS C2624, confirm CED trial enrollment before the procedure date. Billing these codes for Medicare Advantage patients outside of a CMS-approved study will result in a non-covered denial. The CMS CED trial list is at cms.gov. This is not a judgment call — NCD 20.36 is explicit. If your facility is considering IPAPS implantation outside a trial, loop in your compliance officer before scheduling. |
| 3 | Audit your state-specific LCD assignments for lower extremity PTA with stenting. CPT codes 37254 through 37298 (stenting and atherectomy procedures) require LCD compliance where LCDs exist. If your practice bills across multiple states, confirm which MAC jurisdiction applies for each patient location. Missing an LCD requirement is a straightforward denial. |
| 4 | Check prior authorization requirements for cardiology imaging before scheduling. UHC runs a separate prior auth program for cardiology imaging. Visit UHCprovider.com > Cardiology Prior Authorization and Notification. This is separate from the medical necessity criteria in this policy, and a missing prior auth will deny a claim even when clinical criteria are met. |
| 5 | Update your catheter ablation workflow to separate AFib from other arrhythmia indications. CPT 93653 and 93656 cover both, but the coverage policy reference differs. AFib cases use the UHC Commercial Policy on Catheter Ablation for Atrial Fibrillation. Other arrhythmias (including atrial flutter) use InterQual criteria. Make sure your clinical documentation routes to the right standard, and that your billing team knows which criteria set was applied. |
| 6 | Remove Cardiac CT and CCTA from this policy's scope in your internal documentation. If your team currently uses cardiovascular-diagnostic-procedures as the reference for CCTA billing, update that now. The correct policy is the UHC Medicare Advantage Radiologic Diagnostic Procedures policy. Wrong reference document means you're validating claims against the wrong criteria — a silent risk that only shows up at audit. |
| 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 Cardiovascular Procedures Under cardiovascular-diagnostic-procedures
Arterial Compliance Testing
| Code | Type | Description |
|---|---|---|
| 93050 | CPT | Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform |
Catheter Ablation
| Code | Type | Description |
|---|---|---|
| 93653 | CPT | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters — catheter ablation of arrhythmogenic focus (atrial fibrillation) |
| 93656 | CPT | Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters — catheter ablation, pulmonary vein isolation |
Implantable Pulmonary Artery Pressure Sensors (NCD 20.36 — CED Trial Required)
| Code | Type | Description |
|---|---|---|
| 33289 | CPT | Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring |
| 93264 | CPT | Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least one physician analysis, interpretation, and report |
| C2624 | HCPCS | Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components |
Lower Extremity Endovascular Revascularization
| Code | Type | Description |
|---|---|---|
| 37230 | CPT | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel |
| 37231 | CPT | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) |
| 37254 | CPT | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty |
| 37256 | CPT | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty; with stent placement(s) |
| 37258 | CPT | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement(s) |
| 37260 | CPT | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement(s); with atherectomy |
| 37263 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty |
| 37265 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty; with stent placement(s) |
| 37267 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement(s) |
| 37269 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement(s); with atherectomy |
| 37271 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with atherectomy |
| 37273 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with atherectomy; with angioplasty |
| 37275 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with atherectomy; with stent placement(s) |
| 37277 | CPT | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with atherectomy; with stent placement(s) and angioplasty |
| 37280 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty |
| 37282 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty; with stent placement(s) |
| 37284 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement(s) |
| 37286 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement(s); with atherectomy |
| 37288 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with atherectomy |
| 37290 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with atherectomy; with angioplasty |
| 37292 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with atherectomy; with stent placement(s) |
| 37294 | CPT | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with atherectomy; with stent placement(s) and angioplasty |
| 37296 | CPT | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty |
| 37298 | CPT | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal stent placement(s) |
Transcatheter Pulmonary Heart Valve Replacement
| Code | Type | Description |
|---|---|---|
| 33477 | CPT | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the right ventricular outflow tract |
No ICD-10-CM codes are specified in this policy.
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