ModifiedHealth NetPolicy CP.MP.147

Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention

Defines medical necessity criteria and coverage stance for FDA‑approved percutaneous LAA occlusion devices (WATCHMAN, WATCHMAN FLX, Amplatzer Amulet) to reduce stroke risk in adults with non‑valvular atrial fibrillation, and states noncoverage for other percutaneous devices lacking sufficient evidence.

Policy Summary

PayerHealth Net

PolicyPercutaneous Left Atrial Appendage Closure Device for Stroke Prevention

Policy CodePolicy CP.MP.147

Change TypeCriteria revised and clarified

Effective Date

Next Review Date

Key ActionObtain prior authorization for percutaneous transcatheter LAA closure (CPT 33340) and document non‑valvular AF with elevated stroke risk, contraindication or high bleeding risk to long‑term anticoagulation, and ability to tolerate short‑term anticoagulation.

SourceLink

POLICY UPDATE CHANGES

Updated criteria I and II to include all FDA approved percutaneous devices for occlusion of the LAA (WATCHMAN, WATCHMAN FLX, Amplatzer Amulet) and removed verbiage that the WATCHMAN is the only FDA approved device.

Changed criteria wording from 'both' to 'all' of the following in criteria I and removed previously listed specific contraindications, adding criterion I.C 'Ability to tolerate short-term anticoagulants'.

II clarified to state there is a paucity of evidence regarding long-term safety and efficacy of percutaneous devices other than the FDA‑approved devices; such devices are not supported.

3FDA‑approved percutaneous LAA devices named

33340CPT code referenced for procedure

10%early adverse event rate (approx.)

Policy Summary

PayerHealth Net

PolicyPercutaneous Left Atrial Appendage Closure Device for Stroke Prevention

Policy CodePolicy CP.MP.147

Change TypeCriteria revised and clarified

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.

99%procedural success (Amulet registry)

Coverage Criteria for Percutaneous LAA Closure

Initial Therapy / Medical Necessity

Covered when ALL of the following are met:

I: Medical necessity criteria: Device is an FDA‑approved percutaneous LAA occlusion device (WATCHMAN, WATCHMAN FLX, Amplatzer Amulet)

There is an increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2‑VASc scores, and long‑term anticoagulation therapy is recommended

Contraindications or unacceptable high risk of bleeding from long‑term oral anticoagulants

Ability to tolerate short‑term anticoagulants

Not supported / Experimental

II: Non‑covered experimental devices: Percutaneous devices other than the FDA‑approved devices listed (WATCHMAN, WATCHMAN FLX, Amplatzer Amulet) are not supported for LAA occlusion due to a paucity of evidence regarding long‑term safety and efficacy.

Percutaneous devices other than the FDA‑approved devices WATCHMAN, WATCHMAN FLX, and Amplatzer Amulet are excluded from coverage due to insufficient long‑term evidence. Current research indicates there is a paucity of evidence regarding long‑term safety and efficacy for all other percutaneous LAA occlusion devices, and no other devices are FDA‑approved for this indication.

The use of non‑FDA approved percutaneous left atrial appendage (LAA) occlusion devices for stroke prevention in adults with non‑valvular atrial fibrillation is considered not medically necessary / unproven because available research does not support their long‑term safety or effectiveness for this indication.

Providers should follow applicable state Medicaid provisions and Medicare policies when they differ from this clinical policy; state Medicaid coverage provisions take precedence where conflicts exist. For Medicare members, review relevant National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) as part of the benefit and prior authorization assessment. This clinical policy is a guide to medical necessity and does not replace coverage documents or applicable legal and regulatory requirements.

Coding and Scoring

Covered CPT CodesCPTCovered

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

CHA2DS2‑VASc score

CHA2DS2-VASc threshold> 2 (oral anticoagulation recommended per guideline)

Clinical implicationA score > 2 indicates estimated annual stroke risk ~2.2% and supports anticoagulation.

Guideline sourceACC/AHA/HRS guideline recommends CHA2DS2-VASc for stroke risk estimation in AF.

Provider Requirements and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required for percutaneous transcatheter left atrial appendage (LAA) closure (CPT 33340). Requests must be submitted and approved prior to scheduling the procedure.

Affected code: CPT 33340 — Percutaneous transcatheter closure of the left atrial appendage

Note

Prior Authorization Guidance

This clinical policy provides medical necessity criteria used to assist coverage decisions; prior authorization determinations are governed by the member's plan rules and benefits. Providers should follow plan-specific prior authorization submission processes and timelines.

Prior authorization determinations are subject to the terms, conditions, exclusions and limitations of the member's coverage document.

Clinical Background

Atrial fibrillation (AF) is associated with an increased risk of stroke and systemic embolism, and the majority of thrombi form in the left atrial appendage (LAA). Oral anticoagulation guided by CHADS2 or CHA2DS2‑VASc scoring is the standard therapy to reduce stroke risk; percutaneous LAA occlusion devices were developed as an alternative for adults with non‑valvular AF who have a recommendation for long‑term anticoagulation but have contraindications or an unacceptable bleeding risk and who can tolerate short‑term anticoagulation.

Definitions and Device Categories

Stroke risk scoring system

Stroke risk toolCHA2DS2-VASc

PurposeUsed to estimate thromboembolic (stroke) risk in patients with atrial fibrillation.

ComponentsCongestive heart failure, Hypertension, Age ≥75 (2 points), Diabetes, Stroke/TIA/thromboembolism (2 points), Vascular disease, Age 65–74, Sex category (female).

Device categories

Endocardial plug devicesDevices that occlude the ostium of the left atrial appendage (e.g., WATCHMAN, WATCHMAN FLX, Amplatzer Amulet).

Epicardial ligationProcedures that exclude the LAA externally via epicardial ligation (e.g., surgical or percutaneous ligation techniques).

Documentation Required

Required Clinical Documentation for Medical Necessity

Documentation to support medical necessity must demonstrate: non‑valvular atrial fibrillation; increased stroke risk per CHADS2 or CHA2DS2‑VASc with recommendation for LAA closure; contraindication to or unacceptable high bleeding risk with long‑term oral anticoagulation; and ability to tolerate short‑term anticoagulation. Include pertinent clinical notes, risk scores, imaging, and specialist consultation reports.

Confirm non‑valvular AF and provide CHADS2 or CHA2DS2‑VASc score and rationale for LAA closure
Document contraindication or unacceptable high bleeding risk to long‑term oral anticoagulation
Document ability to tolerate short‑term anticoagulation and any relevant imaging (e.g., TEE) or procedural evaluations

Note

Documentation and Applicability

Providers must follow applicable Health Plan coverage documents and state or Medicare rules when submitting requests. For Medicare members review relevant National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs); for Medicaid members, state Medicaid coverage provisions take precedence when they conflict with this policy.

Consult applicable NCDs, LCDs, Medicare Coverage Articles and the state Medicaid manual as applicable
Coverage decisions remain subject to the member's contract, plan exclusions, and administrative policies

Note

Therapeutic Context

Before considering LAA occlusion, assess and document guideline‑directed evaluation of stroke risk (CHA2DS2‑VASc) and an attempt or consideration of oral anticoagulation per current ACC/AHA/HRS guidance unless anticoagulation is contraindicated.

Document CHA2DS2‑VASc score and whether oral anticoagulation was recommended, attempted, or contraindicated

Key distinctionEndocardial devices act from within the atrium to seal the LAA ostium; epicardial ligation excludes the appendage from the outside.

Percutaneous left atrial appendage closure device

DefinitionLeft atrial appendage (LAA) occlusion — percutaneous device-based procedure to mechanically prevent embolization of thrombi originating in the LAA.

PurposeAlternative to long-term anticoagulation for stroke prevention in selected patients with non-valvular AF who have contraindications or cannot tolerate anticoagulants.

Evidence baseSupported by randomized trials and registries (e.g., PROTECT AF/PREVAIL, EWOLUTION) and multiple observational studies and device-specific reports.