Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00152 Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing Form

Effective Date

12/28/2023

Last Reviewed

02/16/2023

Original Document

  Reference



This document addresses wireless cardiac resynchronization therapy (CRT) for left ventricular (LV) pacing. Wireless CRT for LV pacing has been proposed as an alternative to conventionally delivered CRT as a treatment of heart failure.

Note: For additional information, please 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
  • SURG.00150 Leadless Pacemaker

Position Statement

Investigational and Not Medically Necessary:

Wireless CRT for left ventricular pacing is considered investigational and not medically necessary for all indications, including heart failure.