CurrentCapital BluecrossPolicy MP 2.051

Cardiac hemodynamic monitoring for the management of heart failure in the outpatient setting

Policy governing use of implantable pulmonary artery pressure sensors and noninvasive outpatient cardiac hemodynamic monitoring devices for management of chronic heart failure in ambulatory/outpatient settings for Capital Blue Cross members.

Policy Summary

PayerCapital Bluecross

PolicyCardiac hemodynamic monitoring for the management of heart failure in the outpatient setting

Policy CodePolicy MP 2.051

Change TypeNo material change

Effective DateDec 1, 2025

Next Review DateN/A

Key ActionVerify member benefit and prior-authorization requirements and use current billing codes before submitting claims for outpatient hemodynamic monitoring services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

28%HF hospitalization reduction (CHAMPION)

NYHA II-IVNYHA class in evidence

2024Cordella FDA approval year

UncertainNet benefit conclusion

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Cordella 6-mo sensor performance

2020-2025Policy history entries

Coverage Criteria

Investigational — outpatient cardiac hemodynamic monitoring

Covered when ALL of the following are met:

Investigational stance: In ambulatory care and outpatient settings, cardiac hemodynamic monitoring using implantable direct pulmonary artery pressure monitoring, thoracic bioimpedance, inert gas rebreathing, and arterial pressure estimation during the Valsalva maneuver is considered investigational due to insufficient evidence of health outcomes benefit.

Policy refers only to stand-alone cardiac output measurement devices designed for use in ambulatory care and outpatient settings.

Implantable PA sensor evidence

Evidence summary for implantable pulmonary artery pressure sensors:

Evidence overview: For NYHA class II–IV patients with recent heart failure hospitalization and/or elevated natriuretic peptides, evidence for implantable pulmonary artery (PA) pressure sensors includes randomized controlled trials, meta-analyses, and nonrandomized studies. The CardioMEMS device has RCT evidence (CHAMPION) showing a 28% reduction in HF hospitalization; subsequent trials (GUIDE-HF, MONITOR-HF) and meta-analyses show inconsistent results across mortality and functional outcomes, and trial findings may be affected by biases such as clinician/nurse awareness of treatment assignment.

Early safety signals include procedure-related complications (eg, pulmonary artery injury); manufacturer and postapproval analyses have attempted to address bias but have methodologic limitations.

Implantable pulmonary artery sensor systems (CardioMEMS, Cordella)

Summary conclusions regarding implantable pulmonary artery monitoring systems:

Net benefit uncertain: Evidence for CardioMEMS and Cordella systems demonstrates reductions in heart-failure hospitalizations in some analyses but conflicting or inconclusive findings for mortality, quality-of-life, and functional outcomes. Safety and periprocedural complication data are limited for some devices. Overall, the net health benefit is insufficiently established.

Ongoing and planned trials (eg, open-access GUIDE-HF phase, PROACTIVE-HF, PASSPORT-HF) may provide additional clarity.

Thoracic bioimpedance; inert gas rebreathing; Valsalva-derived monitoring

Noninvasive hemodynamic monitoring modalities:

Insufficient evidence: Thoracic bioimpedance, inert gas rebreathing, and arterial pressure monitoring during the Valsalva maneuver lack randomized trial evidence showing improved clinical outcomes; available studies are uncontrolled or diagnostic and do not demonstrate net health benefit.

A single study reported Valsalva-derived LVEDP detection with sensitivity 85% and specificity 80% for LVEDP > 15 mm Hg, but no outcome data demonstrating clinical utility were identified.

This policy applies only to stand-alone cardiac output measurement devices that are designed for use in ambulatory care and outpatient settings. Inpatient uses, integrated hemodynamic monitoring associated with other implanted devices, or settings outside ambulatory/outpatient care are outside the scope of this policy.

The following procedure and HCPCS/CPT codes are explicitly identified in the policy as investigational and not covered when used for outpatient ambulatory cardiac hemodynamic monitoring: 93701, 0608T, 0933T, 0934T, C2624, G0555, 33289, 93050, 93264. In addition, the policy specifies that 93799 is investigational when used for ambulatory/outpatient inert gas rebreathing and is not covered for that indication.

No additional exclusion criteria are stated in the cited policy excerpts. The document references external guidance sources (for example, NICE Interventional Procedures guidance and major society statements) but does not list other explicit exclusions within the provided sections.

The policy considers use of implantable pulmonary artery (PA) pressure sensors (for example, CardioMEMS and Cordella systems) separately in its evidence summaries but, within the ambulatory/outpatient policy statement, categorizes implantable direct PA pressure monitoring as investigational. The evidence summaries note randomized and nonrandomized data that show reduced heart failure hospitalizations in some trials, but overall the net health benefit is considered uncertain pending additional trial results.

For noninvasive modalities, the policy finds that thoracic bioimpedance and inert gas rebreathing lack adequate randomized trial evidence demonstrating improved clinical outcomes and that the evidence is insufficient to determine a net health benefit. A single study of arterial pressure estimation during the Valsalva maneuver reported diagnostic accuracy for detecting LVEDP > 15 mm Hg (sensitivity 85%, specificity 80%) but no outcome data to demonstrate clinical benefit.

Coding

FDA product codes referencedmixed

DXN	FDA product code for VeriCor (noninvasive LVEDP device)
DSB	FDA product code for thoracic impedance plethysmography devices
BZG	FDA product code for inert gas rebreathing devices (Innocor)

Investigational; therefore, not coveredmixedNot Covered

93701	Procedure code listed as investigational
0608T	Procedure code listed as investigational
0933T	Procedure code listed as investigational
0934T	Procedure code listed as investigational
C2624	HCPCS code listed as investigational
G0555	HCPCS code listed as investigational
33289	Procedure code listed as investigational
93050	Procedure code listed as investigational
93264	Procedure code listed as investigational

Investigational for inert gas rebreathingCPTNot Covered

93799

Procedure code: Investigational when used for ambulatory care and outpatient inert gas rebreathing

Policy-related CPT/HCPCS codes referenced in historymixed

C9728	code mentioned in administrative update
0607T	code mentioned in administrative update
0608T	code mentioned in administrative update
C9758	code removed as noted in 08/24/2022 entry
0933T	code added 12/11/2024, effective 01/01/2025
0934T	code added 12/11/2024, effective 01/01/2025
G0555	code added 12/11/2024, effective 01/01/2025

LVEDP threshold

LVEDP thresholdLVEDP > 15 mm Hg

Diagnostic performance (Valsalva-derived study)Sensitivity 85%

Diagnostic performance (Valsalva-derived study)Specificity 80%

Provider Actions & Billing Guidance

Prior Authorization

Product applicability and prior authorization note

This policy is applicable only to certain programs and products administered by Capital BlueCross and is subject to benefit variations (for example, FEP PPO has separate guidance — refer to the FEP Medical Policy Manual). Verify member benefits and prior authorization requirements before proceeding.

Applicable to certain Capital BlueCross programs and products; benefit variations may apply.
FEP PPO: refer to the FEP Medical Policy Manual for coverage details.

Prior Authorization

Investigational codes — prior authorization / coverage verification

Codes listed in this policy may be identified as investigational or not covered for ambulatory/outpatient cardiac hemodynamic monitoring. Identification of a code here does not guarantee coverage — obtain prior authorization or coverage verification as required and document medical necessity in the chart.

Investigational / not covered codes require prior authorization or coverage verification before scheduling.
Identification of a code in this section does not denote coverage; check member benefit terms.

Background

Patients with chronic heart failure are at risk for acute decompensation and hospitalization. Early identification of physiologic deterioration through frequent contact, symptom review, patient education, and medication adjustment is a key strategy to reduce decompensation; outpatient hemodynamic monitoring technologies have been developed to provide more precise physiologic data in the ambulatory setting, but their impact on clinically meaningful outcomes remains unproven per this policy.

Definitions

Outpatient cardiac hemodynamic monitoring devices

DefinitionStand-alone devices designed for ambulatory/outpatient use to estimate cardiac hemodynamics, including implantable pulmonary artery pressure sensors, thoracic bioimpedance systems, inert gas rebreathing devices, and arterial pressure estimation during the Valsalva maneuver.

SettingIntended for outpatient/ambulatory management of heart failure to identify physiologic changes preceding symptoms.

ExclusionsNot intended for inpatient or integrated device uses; policy refers only to stand-alone outpatient devices.

Cardiac output

DefinitionVolume of blood expelled by the ventricles per minute; equal to stroke volume multiplied by heart rate.

Normal rangeA normal resting adult ejects 4 to 8 liters of blood per minute.

Revision History

2025-10-17administrative_updateLatest

Removed Benefit Variations Section and updated Disclaimer.

2025-07-14consensus_review

Consensus review with updates to Policy Guidelines, Background and Rationale; cross-referenced policy removed and references added.

2024-12-11administrative_update

Policy Summary

PayerCapital Bluecross

PolicyCardiac hemodynamic monitoring for the management of heart failure in the outpatient setting

Policy CodePolicy MP 2.051

Change TypeNo material change

Effective DateDec 1, 2025

Next Review DateN/A

Key ActionVerify member benefit and prior-authorization requirements and use current billing codes before submitting claims for outpatient hemodynamic monitoring services.

SourceLink

On This Page

Billing Rule

Billing code updates; follow policy for authorization

Use current billing codes when requesting authorization and billing. The policy is updated periodically to add or remove CPT/HCPCS codes; providers should follow the most recent code list and insurer guidance when submitting claims.

Follow the policy and payer guidance for authorization; code lists are subject to change.
Administrative updates have added and removed CPT/HCPCS codes over time — verify current codes before claim submission.

Documentation Required

Use of implantable direct pressure monitoring

Implantable direct pulmonary artery pressure monitoring devices are discussed in the policy and are considered investigational for ambulatory/outpatient management of heart failure; ensure prior authorization/coverage verification if pursuing device-based monitoring and document rationale.

Implantable pulmonary artery pressure monitoring devices: investigational in the outpatient setting per policy.
Obtain prior authorization/coverage verification and document medical necessity and treatment plan.

Denial Risk

Investigational procedure code for inert gas rebreathing

The procedure code 93799 (unlisted procedure, cardiovascular system) is identified as investigational when used to report inert gas rebreathing for ambulatory/outpatient cardiac hemodynamic monitoring and is therefore considered not covered under this policy.

93799 — Investigational when used for inert gas rebreathing in the ambulatory/outpatient setting; not covered.

Note

No explicit denial triggers are present

There are no explicit denial triggers listed in the policy statement beyond the investigational/not-covered determinations. However, lack of prior authorization, insufficient documentation of medical necessity, or use of codes identified as investigational may result in claim denial. Always verify benefits and obtain authorization when indicated.

No explicit denial triggers specified in the policy statement.
Potential denial risks include missing prior authorization, insufficient documentation, or use of investigational codes.

Documentation Required

Coding and documentation note

Code lists in this policy may not be all-inclusive and are subject to change. Identification of a code here does not denote coverage — maintain thorough documentation linking the service to the patient’s clinical condition and coverage criteria when requesting authorization or submitting claims.

Coding and documentation note: lists may not be all-inclusive; identification does not equal coverage.
Document clinical rationale and tie to medical necessity when submitting for authorization or claims.

Note

Management strategies emphasize frequent patient contact and alternatives

Management alternatives emphasize early identification of patients at risk for decompensation through frequent patient contact, patient education, and medication adjustment. Noninvasive monitoring approaches and structured care programs (office/home visits, telehealth) are recommended management strategies instead of investigational device monitoring in the outpatient setting.

Emphasize frequent contact, symptom review, education, and medication adjustments.
Noninvasive monitoring and structured outpatient management programs are preferred alternatives.

ComponentsCardiac output = stroke volume × heart rate (per minute).

Hemodynamic

DefinitionPertaining to the forces involved in circulating blood through the body.

ContextUsed broadly to describe physiologic measurements and monitoring related to circulation in heart failure management.

RelevanceForms the basis for monitoring technologies that estimate pressure, flow, or impedance as proxies for cardiac function.

Thorax

DefinitionThe cage of bone and cartilage containing the principal organs of respiration and circulation.

Anatomic scopeIncludes structures that cover part of the abdominal organs and house heart and lungs.

Relevance to monitoringThoracic anatomy is the site for noninvasive sensors (e.g., thoracic bioimpedance) used to estimate cardiac hemodynamics.

Valsalva maneuver

DefinitionAn attempt to forcibly exhale with the glottis, nose and mouth closed, causing increased intrathoracic pressure and changes in venous return and pulse.

Physiologic effectsIncreases intrathoracic pressure, slows pulse, decreases venous return to the heart, and increases venous pressure; may increase tympanic membrane pressure if Eustachian tubes are patent.

Use in monitoringUsed to estimate left ventricular end-diastolic pressure (LVEDP) noninvasively by arterial pressure changes during the maneuver.

Remote pulmonary artery pressure-guided management

DefinitionA management approach using implanted pulmonary artery pressure sensors to remotely monitor pressures and guide adjustments in heart failure therapy.

PurposeAims to detect early physiologic changes to reduce acute decompensation and heart failure hospitalizations.

Evidence contextConsensus statements and guidelines have described this approach; ongoing trials aim to clarify net clinical benefit.

Added CPT/HCPCS codes 0933T, 0934T, and G0555 effective 01/01/2025.

2024-07-09consensus_review

Consensus review; no change to policy statement; Background and Rationale updated and references added.

2024-01-18administrative_update

Administrative update: Clinical benefit added.

2023-07-12consensus_review

Consensus review; no change to policy statement; Background and Rationale updated and references added.

2022-08-24consensus_review

Consensus review with revisions to product variation and FEP language; removed code C9758 from the policy.

2021-11-01consensus_review

Consensus review; policy statement unchanged; FEP language, Background, Rationale and References updated.

2020-06-03consensus_review

Consensus review; no change to policy statement; Rationale and References updated.

2020-05-20administrative_update

Administrative update: added codes 0607T and 0608T.

2020-01-01administrative_update

Administrative update: new code C9728 added to the policy.