Percutaneous Patent Foramen Ovale (PFO) Closure (for Tennessee Only)
This policy governs percutaneous PFO closure for prevention of recurrent ischemic stroke and applies to Tennessee Medicaid and CoverKids members aged 18–60; it excludes atrial septal defect closure and individuals under 18.
Added language clarifying that medical records documentation may be required to assess whether the member meets clinical criteria and that documentation must fully support medical necessity.
Added requirement that medical records documentation may be required to assess whether the member meets clinical criteria and that such documentation does not guarantee coverage.
Updated Clinical Evidence, FDA, and References sections to reflect the most current information.
Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and applicable laws which may require coverage for a specific service.
Updated Clinical Evidence, FDA, and References sections to reflect current information and archived previous policy version CS329TN.E.
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.