Does 33927 require prior authorization?

No, 33927 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 33927?

Medicare facility rate: $2313.35. Non-facility rate: $2313.35. Work RVU: 47.78.

Verity

`33927`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

47.78

Facility

$2313.35

Non-Facility

$2313.35

Documentation Required

Medical record documentation must demonstrate cardiogenic shock or severe decompensated heart failure with threatening multi-organ failure and clinical rationale that IABP is not expected to be sufficient.
Documentation must show adherence to applicable FDA approval guidelines for the specific device/procedure (e.g., device labeling, FDA clearance/approval evidence).
For artificial hearts used as destination therapy, documentation must demonstrate that all criteria in NCD 20.9.1 are met per that National Coverage Determination.
No explicit documentation requirements (medical records, test results, or clinical documentation) are provided in the supplied document text.

Key Coverage Criteria

Percutaneous insertion of an endovascular cardiac assist device is covered for patients with cardiogenic shock when intraaortic balloon pump (IABP) therapy is not expected to be sufficient and FDA approval guidelines are strictly followed.
Percutaneous insertion of an endovascular cardiac assist device is covered for patients with severe decompensated heart failure with threatening multi-organ failure when IABP is not expected to be sufficient and FDA approval guidelines are strictly followed.
Artificial hearts (including left ventricular assist devices for destination therapy) are covered for destination therapy when all criteria in NCD 20.9.1 are met and FDA approval guidelines are strictly followed (effective December 1, 2020).
Q0486: Monitor control cable for use with electric/pneumatic ventricular assist device, replacement only
Q0508 | Miscellaneous supply or accessory for use with an implanted ventricular assist device
Advanced heart failure (HF) unmanageable with optimal medical and device-based therapies

4 Active Policies

AMBETTER-CP.MP.127 — Total Artificial Heart

A59657 — Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices

HUMANA-VENTRICULAR-ASSIST-DEVICE-TOTAL-ARTIFICIAL-HEART-MA — Ventricular Assist Device, Total Artificial Heart - Medicare Advantage

ANTHEM-SURG.00145 — SURG.00145 Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)

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33927