Advocating for Pulsed Field Ablation
The Heart Rhythm Society and its advocacy arm, Heart Rhythm Advocates, have been actively advocating to get pulsed field ablation (PFA) covered by private insurers over the past couple years.
Advocating for PFA Coverage
Hear from Amit Shanker, MD, FHRS; Chris Liu, MD, FHRS; and Lisa Miller, Senior Director of Health Policy & Reimbursement at Heart Rhythm Society as they discuss the work behind the scenes to get major insurance companies to cover this life-saving procedure
2024
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February - HRS sent a message to our members stating our intentions to prioritize reimbursement for PFA because we knew providers would experience challenges with coverage and reimbursement.
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March - HRS published a position statement supporting use of PFA as a safe alternative to thermal energy using radiofrequency or cryo ablation to treat atrial fibrillation (Afib).
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March – HRS created an appeal letter template for providers to use for prior authorization and to appeal claim denials.
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April – HRS started tracking private insurers policies to identify those that either deny reimbursement for PFA or list it as experimental or investigational, and initiated outreach to those plans to request a meeting. Aetna, Humana and Elevance Health (formerly Anthem BC/BS) have updated their policies to restrict coverage.
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April – HRS solicited support from the FDA in discussions with insurers to understand why a product would be considered experimental or investigational after FDA approval is obtained.
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May – HRS submitted a CPT code change application to revise the definition for “ablation” in the CPT code book to remove specific energy sources. Prior to 2025, the CPT code book stated, “delivery of ablation via radiofrequency or cryo energy.” This change makes the definition applicable to other energy sources such as PFA and laser. In addition to the definition change, HRS requested an editorial change to the CPT code descriptor (93656) for Afib ablation. The change relocated the language for induction or attempted induction with pacing and recording from the end of the code descriptor to the first part of the descriptor to clarify that an EP study is a requirement for the procedure.
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May – At HRS 2024 annual meeting, there were several scientific sessions and discussions with industry leaders on PFA.
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June – HRS and the FDA met with Elevance Health (formerly Anthem BC/BS) to discuss the criteria the insurer uses to determine medical necessity and designate services as experimental/investigational, and influence an update to their coverage policy as PFA is becoming the standard energy source for treatment of paroxysmal and persistent Afib ablation.
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June – The CPT Editorial Panel approved the editorial changes to CPT code 93656 and revision of the definition for ablation. Those changes were implemented in the CPT code book in 2025.
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August – CMS finalized the new concomitant MS-DRG for LAAO/AF ablation with PFA for FY 2025.
2025
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July – Elevance Health (formerly Anthem BC/BS) revised their Irreversible Electroporation (IRE) policy to remove the heart arrhythmia criteria and ICD-10 procedure code. To date, several plans including Aetna, Cigna, Arkansas BCBS, BCBS Minnesota, BCBS Alabama, Blue Cross Idaho, and BCBS Kansas cover PFA for Afib ablation.
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August – HRS is developing a data collection platform to track long-term outcomes for use of PFA.