CurrentUnitedHealthcarePolicy N/A

Catheter Ablation for Atrial Fibrillation (for New Mexico Only)

This policy governs coverage and medical necessity considerations for catheter ablation to treat atrial fibrillation for UnitedHealthcare members in New Mexico; it excludes members under 18 and arrhythmias other than atrial fibrillation.

Policy Summary

PayerUnitedHealthcare

PolicyCatheter Ablation for Atrial Fibrillation (for New Mexico Only)

Policy CodePolicy N/A

Change TypeMaterial revisions and documentation clarifications

Effective Date

Next Review Date

Key ActionConfirm member meets InterQual clinical criteria and ensure medical record documents relevant history, exam, and test results to support medical necessity.

SourceLink

POLICY UPDATE CHANGES

Replaced reference to InterQual criteria 'Procedures, Electrophysiology (EP) Testing +/- Radiofrequency Ablation (RFA) or Cryothermal Ablation, Cardiac' with 'InterQual CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac'.

Added detailed language describing that benefit coverage is determined by federal, state, or contractual requirements and that medical records documentation may be required to assess clinical criteria and must support medical necessity.

Archived previous policy version CS197NM.B.

New Mexicojurisdictional scope

>=18member age included

93653–93657listed procedure codes

FDA class IIIablation catheter classification

Coverage and Medical Necessity Criteria

Medical necessity (per InterQual)

Covered when ALL of the following are met (per referenced InterQual criteria):

Base criteria: Member is age 18 or older AND diagnosis is atrial fibrillation (arrhythmias other than AF are excluded). Clinical appropriateness must be established using InterQual CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac.

Policy references InterQual for the detailed clinical coverage criteria; this document defers to that source for procedural indications and specifics.

This policy excludes members who are 18 years of age and those with arrhythmias other than atrial fibrillation. Catheter ablation for atrial fibrillation is addressed by this policy; other arrhythmia indications are not covered under this policy's criteria.

The listing of a procedure or diagnosis code in this policy does not imply that the service is covered. Benefit coverage is determined by federal, state, or contractual requirements and applicable laws, which may mandate coverage in some circumstances. Inclusion of a code is for reference only and does not guarantee reimbursement or claim payment.

Applicable Procedure Codes

Policy Summary

PayerUnitedHealthcare

PolicyCatheter Ablation for Atrial Fibrillation (for New Mexico Only)

Policy CodePolicy N/A

Change TypeMaterial revisions and documentation clarifications

Effective Date

Next Review Date

Key ActionConfirm member meets InterQual clinical criteria and ensure medical record documents relevant history, exam, and test results to support medical necessity.

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.

Applicable CPT CodesCPT

93653	Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry.
93655	Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure).
93656	Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing/recording, and His bundle recording, when performed.
93657	Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure).

Provider Documentation & Actionable Notes

Prior Authorization

Clinical criteria and referenced CPT codes

Catheter ablation for atrial fibrillation is considered based on established clinical criteria. Coverage determination is made using the InterQual® CP: Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac. Refer to InterQual for the specific medical necessity criteria that must be met prior to approval.

Clinical criteria: follow InterQual® CP Procedures, Electrophysiology (EP) Testing +/- Catheter Ablation, Cardiac
Coding note: CPT 93653 should not be reported in conjunction with 93656 (AMA, 2024)

Denial Risk

Documentation-related denial risk

Lack of complete, legible, or available documentation may result in denial of the request or inability to determine coverage. Providers should ensure records are included with the request and are accessible upon review.

Denial risk if documentation is missing, illegible, or incomplete
Coverage cannot be guaranteed by submission of records alone; records are used to assess whether InterQual criteria are met

Documentation Required

Required medical record documentation

The patient's medical record must include supporting documentation that demonstrates medical necessity for the requested procedure. This documentation must be legible and made available upon request.

History: relevant cardiac history, prior treatments, symptom burden
Physical exam: findings relevant to atrial fibrillation evaluation
Diagnostic test results: ECG, Holter/event monitor, echocardiogram, prior electrophysiology testing, and any imaging or labs that support the indication
Maintain records in the patient chart and provide upon request to support the InterQual-based review

Note

Provider action / additional note

Ensure administrative and clinical steps are completed when submitting requests to facilitate timely review.

Confirm member is ≥ 18 years and diagnosis is atrial fibrillation (policy does not apply to members < 18 years or to arrhythmias other than atrial fibrillation)
Submit complete clinical documentation alongside any prior authorization or medical review request
If billing, follow AMA coding guidance and do not report CPT 93653 with 93656

Procedure Code Definitions

Definition — CPT 93656

CPT code93656

Short definitionComprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation

Included componentsMay include intracardiac 3‑dimensional electrophysiologic mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing/recording, and His bundle recording when performed

Definitions — CPT 93653, 93655, 93657

CPT code93653

Definition (93653)Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac 3‑dimensional mapping and associated recordings; includes treatment of supraventricular tachycardia by ablation of AV pathway, accessory connection, cavo‑tricuspid isthmus or other single atrial focus

CPT code93655

Definition (93655)Intracardiac catheter ablation of a discrete mechanism of arrhythmia distinct from the primary ablated mechanism; includes repeat diagnostic maneuvers (listed separately in addition to primary procedure)

CPT code93657

Definition (93657)Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (listed separately in addition to primary procedure)

OpenPayer

Catheter Ablation for Atrial Fibrillation (for New Mexico Only)

Coverage and Medical Necessity Criteria

Applicable Procedure Codes

Provider Documentation & Actionable Notes

Clinical Background

Procedure Code Definitions