DraftBlue Cross Blue Shield - Rhode IslandPolicy N/A

Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

Coverage for percutaneous transcatheter left atrial appendage closure (CPT 33340) for stroke prevention in atrial fibrillation for Commercial Products; applies to participating providers using the payer's online authorization tool.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPercutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation

Policy CodePolicy N/A

Change TypeMaterial update (added effective date and online authorization linkage)

Effective DateNov 1, 2025

Next Review DateN/A

Key ActionObtain prior authorization via the payer's online tool and meet the tool's medical criteria for CPT 33340 to be considered medically necessary.

SourceLink

POLICY UPDATE CHANGES

Effective 11/1/2025, CPT 33340 may be considered medically necessary for Commercial Products when medical criteria in the online authorization tool are met.

Prior authorization is recommended and to be obtained via the online tool for participating providers.

2025-11-01Effective date

1CPT codes

CommercialApplicability

2025-08-06

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 Criteria — Commercial Products

Commercial Products — Medical Necessity (via Online Authorization Tool)

Covered when ALL of the following are met:

ALL of the following

Online tool criteria: The procedure (CPT 33340) is considered medically necessary when the specific medical criteria in the payer's Online authorization tool for participating providers are met.see online tool
Detailed clinical eligibility criteria are maintained in the online authorization tool and must be met for coverage.
Prior authorization is recommended and should be obtained via the payer's online authorization tool for participating providers.
Failure to obtain prior authorization or to meet the online tool criteria may result in services being denied or determined not medically necessary.

This policy applies to Commercial Products only. Medicare Advantage Plans are governed separately; see the Related Policies section for applicable Medicare Advantage national and local coverage determinations.

Services determined by the payer to be not medically necessary will not be covered under member benefits. Coverage and payment are subject to the member's subscriber agreement, certificate, and employer agreement, which supersede this policy. Providers should verify member-specific benefits and understand that members generally cannot be billed for services found not medically necessary unless the member has been informed and has agreed in advance to accept financial responsibility.

Coding — Affected Procedure Codes

Covered CPT Codes (Commercial, with criteria)CPTCovered

33340

Percutaneous transcatheter closure of the left atrial appendage with endocardial implant; including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation

Provider Actions — Authorization & Documentation

Prior Authorization

Prior Authorization Required

Prior authorization via online tool — Prior authorization is recommended and must be obtained via the payer's online authorization tool for participating providers. Coverage consideration for CPT 33340 (percutaneous left atrial appendage closure) requires that the provider meet the online tool's medical criteria.

Affected code: CPT 33340

Documentation Required

Online Authorization / Documentation

Online authorization/documentation — Providers must submit prior authorization requests and required clinical documentation through the payer's online authorization tool. If the online tool's medical criteria are not met, or required documentation is not provided through the participating-provider pathway, the service may be denied or not considered medically necessary.

Use payer online authorization tool for submission and documentation
Meeting the online tool's medical criteria is required for consideration

Background — Clinical Rationale

Atrial fibrillation (AF) substantially increases stroke risk through cardioembolism; most embolic strokes in AF originate from the left atrial appendage. Occlusion of the left atrial appendage is a nonpharmacologic alternative to anticoagulation to lower stroke risk. Multiple percutaneously deployed devices have been investigated, and the Watchman and Amplatzer Amulet devices have received FDA approval for stroke prevention in patients with AF.

Definitions

Left atrial appendage closure (LAAC) — definition and purpose

DefinitionPercutaneously deployed device-based occlusion of the left atrial appendage to reduce thromboembolic stroke risk in atrial fibrillation.

PurposeProvide a nonpharmacologic alternative to anticoagulant medications for stroke prevention in patients with atrial fibrillation, since most embolic strokes originate from the left atrial appendage.

Examples of FDA‑approved devicesWatchman and Amplatzer Amulet devices have FDA approval for stroke prevention in patients with atrial fibrillation.

Typical approachProcedure is performed percutaneously using implantable occlusion devices placed in the left atrial appendage to prevent thromboembolism.

Scope in this policyPolicy applies to Commercial Products only; Medicare Advantage Plans are governed by separate related policies.