Catheter Ablation for Atrial Fibrillation
Defines UnitedHealthcare coverage expectations for catheter ablation procedures to treat atrial fibrillation for Commercial and Individual Exchange members aged 18 and over, referencing InterQual clinical criteria for medical necessity.
Replaced reference to InterQual CP: Procedures, Electrophysiology (EP) Testing +/- Radiofrequency Ablation (RFA) or Cryothermal Ablation, Cardiac with InterQual CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac.
Created a shared policy version to support application to Oxford plan membership and added a related Medicare Advantage policy link.
Updated medical records documentation requirements to specify ECG/Holter/rhythm strip for diagnosis, recent physical exam within 3 months, expanded signs/symptoms details, and specific required diagnostics (electrolytes, TSH, ischemia assessment, LVEF).
Revised description for CPT code 93656.
Coverage Criteria
Medical necessity (delegated to InterQual)
Covered when ALL of the following are met per InterQual procedural EP criteria:
InterQual criteria provide detailed indications, prior therapy requirements, and procedural specifications; policy delegates clinical decision logic to InterQual.
This policy explicitly excludes members under 18 years of age and any arrhythmias other than atrial fibrillation. Procedures performed for pediatric members (<18) or for non–atrial fibrillation arrhythmias are not covered under this policy and are outside the scope of the InterQual‑referenced criteria used here.
UnitedHealthcare delegates the detailed clinical decision‑making for catheter ablation indications to InterQual CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac. Coverage is granted only when the member meets the InterQual procedural EP medical necessity criteria; InterQual provides the specific indications, prior therapy requirements, and procedural specifications that determine approval. Providers should refer to the InterQual criteria when submitting requests and include required documentation as indicated by plan rules.
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