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

Noridian covers percutaneous insertion of endovascular cardiac assist devices only for cardiogenic shock or severe decompensated heart failure with impending multi-organ failure when IABP is not expected to be sufficient, and only when FDA approval guidelines are strictly followed. Artificial hearts (including LVADs for destination therapy) are covered when all NCD 20.9.1 criteria are met and FDA approval requirements are satisfied. Coverage is limited to these life‑threatening situations; other indications remain non‑covered pending further evidence.

"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 ..."

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