Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00128 Implantable Left Atrial Hemodynamic Monitor Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



This document addresses implantable left atrial hemodynamic (LAH) monitors. These devices monitor left atrial pressure (LAP) with the objective of identifying pressure changes in ambulatory individuals with heart failure (HF) to potentially enable earlier intervention and prevention of clinical deterioration. The monitoring system can be used as a stand-alone device or in combination with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D).

Note: For information regarding other technologies for cardiac disease, see:

  • CG-SURG-63 Cardiac Resynchronization Therapy with or without an Implantable Cardioverter Defibrillator for the Treatment of Heart Failure
  • CG-SURG-97 Cardioverter Defibrillators
  • MED.00053 Non-Invasive Measurement of Left Ventricular End Diastolic Pressure in the Outpatient Setting
  • MED.00115 Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management

Position Statement

Investigational and Not Medically Necessary:

Left atrial hemodynamic monitoring utilizing implantable device (for example, HeartPOD™ System, Promote® LAP System, and V-LAP™ System) is considered investigational and not medically necessary for all indications.