Does 33426 require prior authorization?

No, 33426 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 33426?

Medicare facility rate: $2231.85. Non-facility rate: $2231.85. Work RVU: 42.20.

Verity

`33426`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

42.20

Facility

$2231.85

Non-Facility

$2231.85

Documentation Required

For CentriMag RVAS: documentation of refractory acute cardiogenic shock due to right ventricular failure and intended temporary use (up to 14 days), including hemodynamic and organ‑function status as relevant.
Pre‑operative hemodynamic data (e.g., central venous pressure [CVP], pulmonary capillary wedge pressure [PCWP], pulmonary artery pulsatility index [PAPi], cardiac index, CVP/PCWP ratio) when assessing risk of right ventricular failure and need for RV support.
Records of prior therapies and attempts at weaning (e.g., failed weaning from inotropes, balloon pump attempts) when asserting device necessity.
For devices with documented safety concerns or recalls (e.g., HeartWare HVAD), documentation of device selection rationale and acknowledgement of risks/alternatives.

Key Coverage Criteria

Aetna considers a Food and Drug Administration (FDA)-approved ventricular assist device (VAD) medically necessary for any of the following FDA-approved indications:
As a bridge to transplant for members who are awaiting heart transplantation and the device has received FDA approval for a bridge to transplant indication (e.g., HeartMate 3 left ventricular assist system (LVAS));
As destination therapy when all of the following criteria are met: The device has received FDA approval for a destination therapy indication; Member has New York Heart Association (NYHA) Class IV end-stage ventricular heart failure and is not a candidate for heart transplant; Member has failed to respond to optimal medical management (including beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors if tolerated) for at least 45 of the last 60 days, or has been balloon pump dependent f [...]
Aetna considers a FDA-approved percutaneous left ventricular assist device (pVAD) (e.g., the TandemHeart and the Impella) medically necessary for the following indications: Providing short-term circulatory support in cardiogenic shock; or as an adjunct to percutaneous coronary intervention (PCI) in the following high-risk members: Members undergoing unprotected left main or last-remaining-conduit PCI with ejection fraction less than 35%; or persons with three vessel disease and ejection fraction [...]
Aetna considers FDA-approved pediatric VADs medically necessary when both of the following criteria are met: Child has documented end-stage left ventricular failure; and an age and size-appropriate VAD will be used until a donor heart can be obtained.
Aetna considers FDA-approved right ventricular assist devices (RVADs; e.g., the CentriMag Right Ventricular Assist System) medically necessary for temporary circulatory support when both of the following criteria are met: RVAD is used for up to 30 days for members in cardiogenic shock due to acute right ventricular failure; and member is willing and able to be treated with heparin or an appropriate alternative anti-coagulant.

2 Active Policies

AETNA-CPB-0182 — Ventricular Remodeling Operation (Batista Procedure) and Surgical Ventricular Restoration (Dor Procedure)

AETNA-CPB-0654 — Ventricular Assist Devices

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33426