SURG.00145 Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)

This policy addresses mechanical circulatory assist devices, including ventricular assist devices (VADs), percutaneous VADs (pVADs), and total artificial hearts. Coverage is medically necessary only for FDA‑approved VADs used per labeling as a bridge to heart transplant in individuals with severe end-stage heart failure who are not expected to survive until a donor heart is available and who are either listed for transplant or undergoing transplant evaluation. All other uses are not medically necessary, including when criteria are not met, pediatric cases that do not meet criteria, and other indications for pVADs and the SynCardia temporary total artificial heart.

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