Symptomatic paroxysmal atrial fibrillation or.As an initial treatment for individuals with recurrent symptomatic paroxysmal atrial fibrillation (greater than one (1) episode, with less than or equal to four (4) episodes in the previous six (6) months) in whom a rhythm-control strategy is desired or.As an alternative to atrioventricular nodal ablation and pacemaker insertion in individuals with class II or III congestive heart failure and symptomatic atrial fibrillation or.Transcatheter radiofrequency ablation or cryoablation to treat atrial fibrillation in individuals who have failed to respond to adequate trials of antiarrhythmic medications may be considered medically necessary for ANY of the following indications: Transcatheter Radiofrequency Ablation or Cryoablation Ischemic or idiopathic cardiomyopathy with ventricular tachycardiaĪ catheter ablation procedure not meeting the criteria as indicated in this policy is considered not medically necessary.Individuals without structural heart disease (i.e., ischemic or idiopathic cardiomyopathy) with symptomatic sustained monomorphic ventricular tachycardia or.Bundle branch reentrant ventricular tachycardia or.For treatment of individuals with ventricular tachycardia with ANY of the following indications:.Symptomatic sustained atrioventricular nodal reentrant tachycardia or.Accessory bypass tract arrhythmia (Wolff-Parkinson-White Syndrome) or.For treatment of individuals with supraventricular tachycardia with ANY of the following indications:.Symptomatic sustained atrioventricular nodal reentrant tachycardia.Ĭomprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters may be considered medically necessary for ANY of the following indications:.Radiofrequency catheter ablation or modification of the atrioventricular junction for ventricular rate control of symptomatic atrial tachyarrhythmias or.Paroxysmal supraventricular tachycardia or.
Atrial tachycardia or atrial flutter or.Atrial ablation for elimination of atrial fibrillation or.Intracardiac catheter ablation of atrioventricular node (AV) function may be considered medically necessary for ANY of the following indications:
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