Percutaneous Patent Foramen Ovale (PFO) Closure (for Ohio Only)
This Ohio-specific medical policy governs coverage and medical necessity criteria for percutaneous PFO closure for prevention of recurrent ischemic (cryptogenic) stroke in adults, excluding atrial septal defect closure and individuals under 18.
Medical records documentation language was added clarifying that documentation may be required to assess whether the member meets clinical criteria and does not guarantee coverage.
Added language clarifying that benefit coverage is determined by federal, state, or contractual requirements and applicable laws which may require coverage for specific services.
Added explicit requirements that medical records documentation may be required to assess whether the member meets clinical criteria and that documentation must support medical necessity and be made available upon request.
Supporting information sections (Clinical Evidence, FDA, and References) were updated to reflect the most current information.
Updated Clinical Evidence, FDA, and References sections to reflect current information.
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.