C1817 Septal defect imp sys

Septal defect implant system, intracardiac

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C1817

1 of 1 payer prior-auth lists that name C1817 require prior authorization or set conditions: Humana.

PayerPlanStatePrior authConditionsSinceSource
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.

Payer coverage policies that name C1817

C1817 appears in 5 coverage policies from Aetna, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaCardiac Devices and Procedures for Occlusion of the Left Atrial Appendage (0791)listed, no stanceJun 25, 2026payer document
AetnaCatheter-Directed Cardiac Procedures (0292)covered if criteria are metAug 4, 2026payer document
CenteneTranscatheter Closure of Patent Foramen Ovale Reference Number: CP.MP.151 (CP.MP.151)covered if criteria are metOct 1, 2024payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Closure Devices for Patent Foramen Ovale and Atrial Septal Defects (SUR707.024)listed, no stanceNov 15, 2025payer document
Premera Blue CrossClosure Devices for Patent Foramen Ovale and Atrial Septal Defects (2.02.09)listed, no stanceJul 13, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • KY: $0.00 (asc), effective Jan 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.