CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Outpatient Cardiac Hemodynamic Monitoring for Heart Failure (Coverage Criteria)

This policy addresses coverage and medical necessity determinations for outpatient cardiac hemodynamic monitoring devices used to manage heart failure (implantable pulmonary artery pressure sensors, thoracic electrical bioimpedance, inert gas rebreathing, and arterial pressure during the Valsalva maneuver) for BCBSRI Medicare Advantage and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyOutpatient Cardiac Hemodynamic Monitoring for Heart Failure (Coverage Criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionVerify member benefits and product-specific coverage: Medicare Advantage covers thoracic electrical bioimpedance (93701) while Commercial products consider it not medically necessary; refer to the member's Benefit Booklet or Evidence of Coverage.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

4monitoring methods reviewed

1CPT covered for MA

3codes not covered / NMN

1coverage discordance (MA vs Commercial)

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage by modality and product type

Coverage determinations by device/modality and product:

Thoracic electrical bioimpedance: Medicare Advantage Plans: covered; Commercial Products: considered not medically necessary due to insufficient evidence

Supported CPT code 93701 (see coding).

Implantable pulmonary artery pressure sensors: Medicare Advantage Plans: not covered; Commercial Products: considered not medically necessary due to insufficient evidence

Includes CardioMEMS; implantation and remote monitoring codes are listed as not covered/not medically necessary.

Inert gas rebreathing and arterial pressure during Valsalva: For both Medicare Advantage and Commercial Products these modalities are not covered or considered not medically necessary as evidence is insufficient to determine effects on health outcomes

Report using unlisted code 93799 when applicable.

Product-specific coverage statements

Product-specific coverage stance as stated in document:

Medicare Advantage - Bioimpedance: CPT 93701 is covered for Medicare Advantage Plans

See code group for status

Commercial - Bioimpedance: CPT 93701 is considered not medically necessary for Commercial Products

See code group for status

Wireless pulmonary artery sensor - All Products: CPT 33289, 93264, and G0555 are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products

Codes listed as not covered / not medically necessary

Inert gas rebreathing / LVEDP: There are no specific codes for inert gas rebreathing measurement or left ventricular end-diastolic pressure; these should be reported using unlisted cardiovascular code 93799

Refer to Unlisted Procedures related policy

For outpatient heart failure management, implantable direct pulmonary artery (PA) pressure monitoring, inert gas rebreathing, and arterial pressure measurement during the Valsalva maneuver are not covered under Medicare Advantage Plans and are considered not medically necessary for Commercial Products because the evidence is insufficient to determine effects on health outcomes. This stance applies to implantable PA sensors (e.g., CardioMEMS and other investigational sensors) and the specified noninvasive physiologic measurement techniques.

The policy rationale cites limited and mixed evidence for outpatient use of these modalities; although some implantable PA sensors have FDA regulatory history (for example, CardioMEMS received PMA), the available studies do not provide sufficient evidence of improved clinical outcomes to support routine coverage or medical necessity for the listed modalities in the outpatient heart failure population.

The following procedure codes for implantation and monitoring of a wireless pulmonary artery pressure sensor are explicitly listed as not covered for Medicare Advantage Plans and not medically necessary for Commercial Products: 33289 (transcatheter implantation of a wireless PA pressure sensor), 93264 (remote monitoring of a wireless PA pressure sensor, up to 30 days), and G0555 (provision of replacement patient electronics system for home PA pressure monitoring; new code effective 1/1/2025). Claims using these codes for the described services risk denial.

Thoracic electrical bioimpedance (reported by CPT 93701) is covered for Medicare Advantage Plans but is considered not medically necessary for Commercial Products due to insufficient evidence of benefit. For implantable PA sensors, inert gas rebreathing, and arterial pressure during Valsalva, the policy states these modalities are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products.

When inert gas rebreathing or left ventricular end-diastolic pressure measurements are performed and no specific code exists, providers should report the service using the unlisted cardiovascular code 93799, recognizing that such claims may be subject to additional review or denial if considered not medically necessary.

CPT 93701 (bioimpedance-derived physiologic cardiovascular analysis) is specifically identified in the policy as covered for Medicare Advantage Plans and as not medically necessary for Commercial Products. Providers should verify product-specific benefits and follow applicable payer rules when billing this code.

CPT/HCPCS Coding and Status

Covered CPT Codes (Medicare Advantage) / Not medically necessary (Commercial)CPT

93701

Bioimpedance-derived physiologic cardiovascular analysis

Not covered / Not medically necessary codes for implantable PA sensorCPT | HCPCSNot Covered

33289	Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed
93264	Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional
G0555	Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring (New Code Effective 1/1/2025)

Unlisted codes (inert gas rebreathing, LVEDP)CPT

93799

Unlisted cardiovascular service or procedure (used for inert gas rebreathing or LVEDP measurement)

Bioimpedance monitoringCPT

93701

Bioimpedance-derived physiologic cardiovascular analysis

Wireless pulmonary artery pressure sensor implantation and monitoringmixedNot Covered

33289	Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed
93264	Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional
G0555	Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring (New Code Effective 1/1/2025)

Unlisted cardiovascular proceduresCPT

93799

Unlisted cardiovascular service or procedure

Provider Actions, Billing Rules, and Documentation

Prior Authorization

Prior Authorization and Benefit Verification

Prior authorization is not applicable for this policy. Coverage and benefit rules vary by product line; providers should verify benefits and prior authorization requirements with the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement before providing services.

Prior authorization: Not applicable
Benefit verification required: Check member-specific documents for limits and prior auth rules

Note

Coverage Distinction for CPT 93701 (Bioimpedance Monitoring)

Coverage for cardiac hemodynamic monitoring using thoracic electrical bioimpedance (CPT 93701) differs by product. CPT 93701 is covered for Medicare Advantage Plans but is considered not medically necessary for Commercial Products.

CPT 93701: Covered for Medicare Advantage Plans
CPT 93701: Not medically necessary for Commercial Products

Documentation Required

Device Implantation and Documentation Requirements

Implantation of a pulmonary artery (PA) sensor requires right heart catheterization and device documentation. The CardioMEMS device is implanted via a transvenous heart catheter system (femoral vein access) and typically requires overnight hospital observation after implantation. Document procedural details, device model, implantation site, and post-procedure monitoring.

Device implantation requires right heart catheterization
Document device model, implantation site, transmission/monitoring method, and observation details

Denial Risk

Not Covered Implantable Device Implantation and Monitoring Codes

The following implantable PA sensor implantation and monitoring codes are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products. Use of these codes or related services may result in claim denial.

CPT 33289 — Transcatheter implantation of wireless pulmonary artery pressure sensor: Not covered / Not medically necessary
CPT 93264 — Remote monitoring of a wireless pulmonary artery pressure sensor (up to 30 days): Not covered / Not medically necessary
HCPCS G0555 — Replacement patient electronics system for home pulmonary artery pressure monitoring (New code effective 1/1/2025): Not covered / Not medically necessary

Denial Risk

Potential Denial Triggers and Billing Risks

Potential denial triggers include billing the implantable pulmonary artery sensor implantation or remote monitoring codes listed as not covered, reporting inert gas rebreathing or LVEDP measurements with inappropriate/unsupported codes, or failing to verify member-specific benefits. Providers should ensure services align with product-specific coverage and document medical necessity when applicable.

Use of CPT 33289, CPT 93264, or HCPCS G0555 may trigger denial
Inert gas rebreathing or LVEDP: report with unlisted cardiovascular code 93799
Failure to verify member benefits or provide required documentation may result in denial

Billing Rule

Unlisted Procedure Reporting (Inert Gas Rebreathing / LVEDP)

There is no specific CPT code for inert gas rebreathing measurement or direct LVEDP reporting; report these using the unlisted cardiovascular procedure code 93799 and include supporting documentation and references in the claim to justify the service.

Report inert gas rebreathing or LVEDP with CPT 93799 (Unlisted cardiovascular service or procedure)
Include detailed documentation to support the unlisted procedure claim

Background and Context

Outpatient cardiac hemodynamic monitors are intended to detect physiologic changes that precede acute decompensation in patients with heart failure, with the goal of enabling earlier intervention to prevent hospitalization. Traditional inpatient invasive monitoring and routine noninvasive testing (e.g., echocardiography) are distinct from newer outpatient technologies.

Newer outpatient modalities addressed by this policy include implantable pulmonary artery (PA) pressure sensors (implantable devices that transmit ambulatory PA pressure readings), thoracic electrical bioimpedance (noninvasive estimation of stroke volume and cardiac output), inert gas rebreathing (technique estimating cardiac blood flow from disappearance of a soluble gas), and arterial pressure during the Valsalva maneuver (a noninvasive method used to estimate left ventricular end-diastolic pressure). The evidence for many of these outpatient monitoring approaches is insufficient to demonstrate consistent improvements in health outcomes, which has informed the differentiated coverage positions by product line.

Definitions

Thoracic bioimpedance (impedance cardiography) — definition and measurement method

TermThoracic bioimpedance (impedance cardiography)

DefinitionMeasurement of electrical resistance across the thorax to estimate stroke volume and cardiac output based on pulsatile changes in blood-filled thoracic structures.

Measurement methodSmall electrical signals are transmitted through the thorax; changes in bioimpedance during each heartbeat are inversely related to pulsatile changes in aortic blood volume and velocity, from which stroke volume and cardiac output are calculated.

Inert gas rebreathing — definition and technique

TermInert gas rebreathing

DefinitionTechnique estimating cardiac blood flow by measuring disappearance of a blood-soluble gas during rebreathing alongside an insoluble gas to compute lung volume and blood flow.

Technique detailsPatient breathes from a rebreathing bag containing oxygen plus fixed proportions of a soluble gas (e.g., nitrous oxide) and an insoluble gas (e.g., sulfur hexafluoride); disappearance rate of the soluble gas proportional to pulmonary blood flow while the insoluble gas determines lung volume; gases and CO2 are measured continuously at the mouthpiece.

Arterial pressure during Valsalva to estimate LVEDP — definition and correlation

TermArterial pressure during Valsalva to estimate LVEDP

DefinitionNoninvasive method recording arterial pressure responses during the strain phase of the Valsalva maneuver that correlate with left ventricular end-diastolic pressure (LVEDP).

Correlation/UseArterial pressure responses during repeated Valsalva maneuvers are recorded and analyzed to produce values that correlate with invasively measured LVEDP; LVEDP is elevated in acute decompensated heart failure.

Implantable pulmonary artery (PA) pressure sensor — definition and example

TermImplantable pulmonary artery (PA) pressure sensor

DefinitionA sensor implanted in the pulmonary artery (distal PA or right ventricular outflow tract) that wirelessly transmits pressure readings to external systems for ambulatory hemodynamic monitoring.

Example and implantationCardioMEMS Champion Heart Failure Monitoring System (now Abbott) is an FDA‑cleared implantable PA sensor; implantation is performed via right heart catheterization (transvenous delivery) with postprocedure observation, and the device transmits PA pressures to a secure database.

Wireless pulmonary artery pressure sensor — definition (e.g., CardioMEMS) and intended use

TermWireless pulmonary artery pressure sensor (e.g., CardioMEMS)

DefinitionAn implantable device for long-term ambulatory pulmonary artery pressure monitoring that transmits pressure measurements wirelessly to external receivers and databases to guide heart failure management.

Intended useIntended to guide outpatient management of heart failure by providing ambulatory PA pressure measurements; associated CPT codes for implantation and remote monitoring include 33289 and 93264 (listed as not covered/not medically necessary in this policy).

Thoracic electrical bioimpedance (TEB) — noninvasive monitoring method and CPT 93701 reference

TermThoracic electrical bioimpedance (TEB)

DefinitionNoninvasive cardiac hemodynamic monitoring method reported by CPT 93701: bioimpedance-derived physiologic cardiovascular analysis.

Coding referenceCPT 93701 — Bioimpedance-derived physiologic cardiovascular analysis (policy: covered for Medicare Advantage; considered not medically necessary for Commercial Products).

Unlisted cardiovascular service — use of CPT 93799 for services without a specific CPT/HCPCS code

TermUnlisted cardiovascular service

DefinitionProcedures or measurements that do not have a specific CPT or HCPCS code (e.g., inert gas rebreathing or LVEDP estimation) should be reported using CPT 93799 (Unlisted cardiovascular service or procedure).

Billing guidanceWhen reporting inert gas rebreathing or left ventricular end diastolic pressure measurements, submit with unlisted cardiovascular code 93799 and reference related Unlisted Procedures policy as needed.

OpenPayer

Outpatient Cardiac Hemodynamic Monitoring for Heart Failure (Coverage Criteria)

Coverage Criteria by Modality and Product

CPT/HCPCS Coding and Status

Provider Actions, Billing Rules, and Documentation

Background and Context

Definitions