Percutaneous left atrial appendage closure

Applies to:

All plans

Definition

The left atrial appendage (LAA) is a tubular structure that opens into the left atrium and has been shown to be one potential source for blood clots that can cause strokes. While thinning the blood with anticoagulant medications has been proven to prevent strokes, percutaneous LAA closure has been studied as a non-pharmacologic alternative for patients with non-valvular atrial fibrillation who are at high risk for stroke.

Medical policy

Percutaneous Left Atrial Appendage Closure - 91605

Percutaneous left atrial appendage closure coverage

Unless otherwise specified in our members' plan documents, Priority Health covers percutaneous left atrial appendage closure (LAAC) using FDA-approved devices for stroke risk reduction in patients with atrial fibrillation when all of the criteria identified in the medical policy are met.

Percutaneous left atrial appendage closure authorizations

Authorization is required:

For all patients, for all procedures.

Participating providers: Use the Auth Request tool to go to Clear Coverage™

Non-par providers: Use the Medical prior authorization form. 

Authorization is not required:

N/A

Pre-service education is required before authorization

Providers must complete a counseling and shared decision-making visit with the patient to go over instructions for using oral anticoagulation drugs prior to the LAAC procedure before we will authorize payment. Shared decision-making is a collaborative process where the provider helps the patient understand the decision and its consequences, and then helps them apply their values and preferences in order to make a decision.

The visit must:

• Be done with an independent, non-interventional physician
• Include an evidence-based decision tool like Emmi^®
• Be documented in the medical record