Percutaneous Patent Foramen Ovale (PFO) Closure
Defines UnitedHealthcare's medical policy governing percutaneous PFO closure for prevention of recurrent ischemic stroke and other neurologic indications in adults; specifies patient selection, documentation, and coding references for commercial and community plans.
No material clinical or coverage changes in this revision.
Coverage Criteria for Percutaneous PFO Closure
Medically necessary indications
Covered when ALL of the following are met
Use according to FDA labeled indications, contraindications, warnings, and precautions.
This policy does not apply to individuals < 18 years of age and does not apply to atrial septal defect closure. These exclusions are specific to the application of percutaneous patent foramen ovale (PFO) closure under this coverage policy.
Percutaneous PFO closure is considered unproven and not medically necessary for all other stroke or related neurological indications beyond the covered indication for prevention of recurrent ischemic stroke. Examples include, but are not limited to, primary prevention of stroke, transient ischemic attacks (TIA), and migraine prevention.
Applicable Billing and Procedure Codes
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