0273T — Interrogation device evaluation (in person) carotid sinus baroreflex activation system, with programming
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of continued symptoms despite guideline-directed medical therapy.
- Clinical documentation of NYHA functional class (III, or II with recent history of III).
- Objective LVEF measurement (e.g., echocardiogram) showing LVEF ≤ 35%.
- NT-proBNP laboratory result demonstrating value < 1600 pg/mL.
Key Coverage Criteria
- Use of baroreflex stimulation devices as an alternative treatment for heart failure
- Use in patients with heart failure who are unresponsive to conventional medical therapy and lifestyle interventions
- 2014 Humanitarian Device Exemption (HDE) use: treatment-resistant hypertension in patients who received Rheos® carotid sinus leads as part of the Rheos pivotal trial and were considered responders
- Improvement of symptoms of heart failure (quality of life, six-minute walk, functional status) in patients who remain symptomatic despite guideline-directed medical therapy, who are NYHA Class III or NYHA Class II with a recent history of Class III, with left ventricular ejection fraction (LVEF) ≤ 35% and NT-proBNP < 1600 pg/mL.
- Barostim Neo for treatment of heart failure in patients who are New York Heart Association (NYHA) Class III.
- Barostim Neo for treatment of heart failure in NYHA Class II patients who have a recent history of NYHA Class III.
6 Active Policies
BCBSIL-THE801.034 — Baroreflex Stimulation Devices
BCBSMT-THE801.034 — Baroreflex Stimulation Devices
BCBSNM-THE801.034 — Baroreflex Stimulation Devices
BCBSOK-THE801.034 — Baroreflex Stimulation Devices
REGENCE-SUR183 — Baroreflex Stimulation Devices
Related Codes
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