Q0508 — Miscellaneous supply or accessory for use with an implanted ventricular assist device
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
- Serial blood and urine testing may be used to verify abstinence from substances of concern.
- Documented assessment of substance use and either objective evidence of abstinence/risk‑reduction behaviors or a documented commitment to reduce behaviors when urgent transplant timelines apply.
- Documentation of caregiver availability/support and evidence of patient adherence/compliance.
- Documentation of malignancy prognosis and evaluations supporting the absence of life‑limiting cancer within five years, and documentation of severity of renal, hepatic, or pulmonary dysfunction when applicable.
Key Coverage Criteria
- VAD use when the heart is too weak to pump adequate blood to the body (support for severe heart failure or poor cardiac output).
- Temporary use as a bridge to transplant to sustain a patient until heart transplantation can be performed.
- Temporary use as a bridge to recovery, including as an adjunctive device in high‑risk percutaneous coronary interventions.
- Use as a replacement for a damaged or diseased heart when mechanical circulatory support is required.
- Short-term mechanical circulatory support as bridge to recovery for myocardial infarction complicated by cardiogenic shock.
- Short-term mechanical circulatory support as bridge to recovery for high-risk percutaneous coronary interventions (PCI).
1 Active Policy
AMBETTER-CP.MP.46 — Ventricular Assist Devices
Related Codes
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