Percutaneous Transluminal Septal Myocardial Ablation (PTSMA)

PTSMA (alcohol septal ablation) is covered as medically necessary in adults with classical asymmetric subaortic HOCM only when ALL of the following are met: severe symptoms ≥6 months despite optimal medical therapy/dual‑chamber pacing or prior ineffective myotomy/myectomy, NYHA class III–IV, echocardiographic LV wall thickness >13 mm (>15 mm in athletes), and LVOT gradients meeting thresholds (resting >30 mm Hg or provoked >60 mm Hg — or, for less severe symptoms, resting >50 mm Hg or provoked >100 mm Hg). It is explicitly not indicated for mid‑ventricular obstruction, concealed membranous subaortic stenosis, or supravalvular obstruction.

"Percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion is medically necessary for hypertrophic obstructive cardiomyopathy (HOCM) in adults when all ..."

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