33928
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
- 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)
Related Codes
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