93591
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
17.52
Facility
$751.85
Non-Facility
$751.85
Documentation Required
- Documentation that a multidisciplinary heart team (including a cardiac surgeon and an interventional cardiologist) evaluated the patient and determined the patient to be at risk for open-heart surgery (names/roles and decision rationale).
- Post-procedure imaging records demonstrating successful implantation (angiography, CTA, or echocardiography results).
- No documentation requirements are specified in this document chunk.
- No documentation requirements are stated in the provided excerpt
Key Coverage Criteria
- No explicit covered indications, diagnoses, conditions, or clinical scenarios are present in the provided document text. The provided text contains only the policy header/table of contents and instructions.
- No covered indications, diagnoses, or clinical scenarios are specified in this document.
- Document directs users to the CMS Medicare Coverage Database for current applicable National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Local Coverage Articles (LCAs) that define covered indications.
- Transcatheter or percutaneous approach to cardiac valve procedures as an alternative to traditional open‑heart surgery for valve replacement or repair.
- Transcatheter Aortic Valve Replacement (TAVR) — NCD 20.32 (aortic valve disease / aortic valve replacement).
- Transcatheter Edge‑to‑Edge Repair (TEER) for Mitral Valve Regurgitation — NCD 20.33 (mitral valve regurgitation repair).
1 Active Policy
HUMANA-TRANSCATHETER-VALVE-PROCEDURES-MA — Transcatheter Valve Procedures - Medicare Advantage
Related Codes
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