Q0491, Emergency power source for use with electric/pneumatic ventricular assist
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
- No explicit documentation requirements (medical records, test results, or clinical documentation) are provided in the supplied document text.
- Refer to Medicare Benefit Policy Manual, Chapter 15, §120 Prosthetic Devices for relevant documentation guidance.
- Refer to full texts of NCD 260.9 (Heart Transplants), NCD 310.1 (Routine Costs in Clinical Trials), and NCD 20.9.1 (Ventricular Assist Devices) for required documentation elements.
- Refer to full LCA articles A59657, A59658, A53988, A53986 for specific documentation requirements — none are specified in this excerpt.
Key Coverage Criteria
- 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
- Use of mechanical circulatory support (MCS) from a ventricular assist device (VAD) or total artificial heart (TAH) as a treatment option
- Short-term mechanical circulatory support
- Long-term mechanical circulatory support
5 Active Policies
HUMANA-VENTRICULAR-ASSIST-DEVICE-TOTAL-ARTIFICIAL-HEART-MA, Ventricular Assist Device, Total Artificial Heart
BCBSIL-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts
BCBSMT-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts
BCBSNM-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts
BCBSOK-SUR707.017
Related Codes
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