MM14149 - National Coverage Determination 20.37: Transcatheter Tricuspid Valve Replacement

Transcatheter tricuspid valve replacement (TTVR) is covered for patients with symptomatic severe tricuspid regurgitation who are not candidates for surgical intervention, provided they meet specific criteria outlined in National Coverage Determination 20.37 and are enrolled in a CMS-approved coverage with evidence development (CED) study. Key limitations include the exclusion of patients with active infections or significant co-morbidities, and coverage is restricted to facilities participating in these approved clinical trials for a minimum of 24 months. Documentation must demonstrate symptoms related to tricuspid regurgitation, and prior authorization along with necessary imaging studies is required.

"Medically necessary for patients with symptomatic severe tricuspid regurgitation who are not suitable candidates for surgical intervention."

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