0496T — Mntr cdvr don lng ea addl hr
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Clinical documentation demonstrating end-stage cardiac and pulmonary disease.
- Documentation justifying why single-organ transplant and/or maximal medical therapy for heart failure are insufficient or contraindicated for this patient.
- Clinical documentation of deterioration despite optimal therapy (progression notes, treatment history).
- Hemodynamic measurements showing right atrial pressure (>15 mm Hg).
Key Coverage Criteria
- Heart/lung transplantation for carefully selected individuals with end-stage cardiac and pulmonary disease.
- Irreversible primary pulmonary hypertension with heart failure.
- Nonspecific severe pulmonary fibrosis with severe heart failure.
- Eisenmenger complex with irreversible pulmonary hypertension and heart failure.
- Cystic fibrosis with severe heart failure.
- Chronic obstructive pulmonary disease (COPD) with heart failure.
5 Active Policies
BCBSIL-SUR703.006 — Heart/Lung Transplant
BCBSMT-SUR703.006 — Heart/Lung Transplant
BCBSNM-SUR703.006 — Heart/Lung Transplant
BCBSOK-SUR703.006 — Heart/Lung Transplant
SUR703.006 — Heart/Lung Transplant
Related Codes
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