Ventricular Assist Devices

This policy covers implantation and use of ventricular assist devices (VADs) for mechanical circulatory support — including short‑term support for cardiogenic shock/high‑risk PCI, bridge to transplant or recovery, destination LVAD therapy for select NYHA Class IV patients, and FDA‑approved pediatric VADs per device labeling. Coverage is limited to FDA‑approved or HDE‑approved devices used according to device‑specific inclusion/exclusion, age and body‑size criteria, with requirements such as prior failure of optimal medical therapy and absence of contraindications (e.g., noncardiac life expectancy ≤2 years, irreversible multi‑organ dysfunction, active substance use, or inadequate caregiver support); devices or uses outside approved indications are excluded.

"VAD use when the heart is too weak to pump adequate blood to the body (support for severe heart failure or poor cardiac output)."