Dear Heart Rhythm Society Member:

Currently, some private payers, including some Blue Cross Blue Shield of America (BCBSA) carriers, do not provide reimbursement for transcatheter ablation to treat atrial fibrillation (AF). BCBSA’s Technology Evaluation Center (TEC) conducted an assessment of transcatheter ablation, which concluded that there is not sufficient evidence to determine if it is effective in treating AF. While some local BCBS carriers cover transcatheter ablation in spite of the TEC assessment, many local carriers as well as other insurers have based their non-coverage decisions on the assessment, which included a limited review of literature that met coverage criteria. Despite these non-coverage decisions, ablation therapy for the treatment of atrial fibrillation has become a standard option for the treatment of highly symptomatic AF in patients who have either failed treatment with, or are intolerant of, drug therapy.

The Heart Rhythm Society (HRS), in conjunction with the American College of Cardiology (ACC) and the American Heart Association (AHA), recently published Atrial Fibrillation Management Guidelines. HRS will be working with ACC to request that private payers reconsider their non-coverage decisions in light of the management guidelines. The management guidelines support radiofrequency ablation procedures for atrial fibrillation if prior antiarrhythmic therapy has failed, or as an alternative to amiodarone in younger patients.

HRS will be proactively communicating with the nation’s private payers to advocate for the coverage and reimbursement of ablation procedures for atrial fibrillation if prior antiarrhythmic therapy has failed or as an alternative to amiodarone in younger patients based on the above internationally recognized guidelines.

Earlier this year, HRS and ACC advocacy efforts were successful in working with Wellpoint to change its non-coverage policy. As a result of these efforts, Wellpoint now has a policy stating that transcatheter radiofrequency ablation of arrhythmogenic foci in the pulmonary veins is considered medically necessary as a treatment of atrial fibrillation when the patient is symptomatic and is resistant to two or more antiarrhythmic drugs, or has intolerance of or a contraindication to appropriate antiarrhythmic drug therapy.

For additional information, contact Lisa Miller Director, Reimbursement and Regulatory Affairs, at (202) 464-3433 or via e-mail at lmiller@hrsonline.org.

Sincerely,

Dwight Reynolds, MD, FHRS
President
Heart Rhythm Society