CurrentCentenePolicy CP.MP.160

Implantable Wireless Pulmonary Artery Pressure Monitoring

This policy governs coverage stance for implantable wireless pulmonary artery (PA) pressure monitoring devices (e.g., CardioMEMS) for non-Medicare Centene-affiliated health plans, describing clinical context, evidence summary, and coding implications affecting providers seeking authorization or reimbursement.

Policy Summary

PayerCentene

PolicyImplantable Wireless Pulmonary Artery Pressure Monitoring

Policy CodePolicy CP.MP.160

Change TypeAnnual review (no material changes)

Effective Date

Next Review Date

Key ActionWhen submitting prior authorization requests, include device model, implant procedure (e.g., CPT 33289), remote monitoring plan (e.g., CPT 93264), and supply code (e.g., HCPCS C2624) and reference the plan policy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CardioMEMSFDA device

1%Complication rate

NYHA IIIFDA indication

33289/93264/C2624Key codes

Coverage Criteria — Implantable Wireless Pulmonary Artery Pressure Monitoring

Policy coverage statement

Covered when ALL of the following are met

Non‑Medicare coverage stance: The long-term safety and effectiveness of implantable wireless pulmonary artery pressure monitoring has not been proven for any indication, including the management of heart failure, for non‑Medicare Centene‑affiliated health plans.

Policy declares investigational / not established coverage for non‑Medicare plans; see Medicare-specific criteria at MC.CP.MP.160 when applicable.

The policy for non‑Medicare Centene‑affiliated health plans states that the long‑term safety and effectiveness of implantable wireless pulmonary artery (PA) pressure monitoring devices has not been proven for any indication. As a result, coverage is not established for these devices for non‑Medicare Centene‑affiliated plans, including use for heart failure management.

Available randomized trial data (CHAMPION) demonstrated reductions in heart‑failure hospitalizations over short‑to‑midterm follow‑up, but important limitations remain. The evidence is therefore considered insufficient to support outpatient use of ambulatory implantable pulmonary artery pressure measurement devices because of limited long‑term health‑benefit data (including survival), incomplete safety and quality‑of‑life data, and concerns about study conduct and generalizability.

Policy Summary

PayerCentene

PolicyImplantable Wireless Pulmonary Artery Pressure Monitoring

Policy CodePolicy CP.MP.160

Change TypeAnnual review (no material changes)

Effective Date

Next Review Date

SourceLink

On This Page

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.

Provider Actions — Authorization, Documentation, and Denial Risk

Prior Authorization

Prior Authorization Note

For non‑Medicare Centene‑affiliated plans, coverage is not established. Prior authorization submissions should be sent according to plan-specific processes; include full clinical rationale and supporting documentation to facilitate review.

Applies to all non‑Medicare Centene‑affiliated plans

Denial Risk

Noncoverage / Denial Risk

The long‑term safety and effectiveness of implantable wireless pulmonary artery pressure monitoring has not been established for any indication; requests may be denied.

Denial risk based on insufficient long‑term evidence

Documentation Required

Required Documentation Elements

Provide comprehensive documentation with the authorization request to support medical necessity.

Device model and manufacturer (e.g., CardioMEMS HF System, St. Jude Medical)
Implant procedure details — include CPT 33289 and operative report
Remote monitoring plan — include frequency of downloads, responsible clinician, and documentation of weekly data reviews (e.g., CPT 93264 where applicable)
Supporting clinical documentation — NYHA class, recent HF hospitalizations (within prior 12 months), contraindications to anticoagulation, and other relevant records

Denial Risk

Noncoverage Risk — Long‑Term Safety and Effectiveness Not Established

Requests for implantable wireless pulmonary artery pressure monitoring may be denied because long‑term safety and effectiveness have not been proven for any indication, including heart failure management. Refer Medicare cases to MC.CP.MP.160 for Medicare criteria.

Non‑Medicare plans: coverage not established
Refer to MC.CP.MP.160 for Medicare criteria

Definitions and Device Details

CardioMEMS HF System — device description, implant method, and data transmission

Device nameCardioMEMS HF System

Primary functionWirelessly measures and transmits daily pulmonary artery (PA) pressures (systolic, diastolic, mean) and heart rate to clinicians

Sensor descriptionDime-sized implantable PA sensor permanently implanted in the pulmonary artery

Implant methodFluoroscopy-guided right-heart catheterization (transvenous catheter delivery system)

ComponentsImplantable sensor, transvenous delivery catheter, patient home monitoring system (antenna pillow, bedside monitor, remote button), secure internet-accessible database

Data transmissionEach reading captures ~18 seconds of pressure data which is wirelessly transmitted from the home monitoring unit to a secure database accessible to clinicians

Contraindication (brief)

Contraindication — anticoagulation/antiplateletContraindicated in patients unable to take dual antiplatelet therapy or anticoagulants for one month post‑implant

Timing relevanceOne-month post-implant period specified for required antiplatelet/anticoagulant therapy

Clinical implicationPatients with bleeding disorders or contraindications to short-term antithrombotic therapy may not be suitable candidates for implantation

OpenPayer

Implantable Wireless Pulmonary Artery Pressure Monitoring

Coverage Criteria — Implantable Wireless Pulmonary Artery Pressure Monitoring

Coding — Procedure, Remote Monitoring, and Supply Codes

Provider Actions — Authorization, Documentation, and Denial Risk

Background — Clinical Context

Definitions and Device Details