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

Effective for dates of service on/after February 3, 2014.Noridian will cover the percutaneous insertion of an endovascular cardiac assist device itself under limited conditions. Until the literature clearly demonstrates the efficacy of the treatment approach, coverage may be made only in the following two life-threatening situations and only when external counterpulsation (intraaortic balloon pump, IABP) is not expected to be sufficient; Cardiogenic shock or Severe decompensated heart failure with threatening multi-organ failure.This service will only be covered when the FDA approval guidelines are strictly followed. Due to the expansion of NCD 20.9.1-Ventricular Assist Devices (VADs) to include left ventricular assist devices for long-term (destination therapy) mechanical circulatory support per Change Request 12290, Noridian will cover artificial hearts for destination therapy when all the criteria outlined NCD 20.9.1 are met and the FDA approval guidelines are strictly followed effective December 1, 2020.