Ultrafiltration in Decompensated Heart Failure

This policy addresses ultrafiltration (aquapheresis), including continuous and extended use with the Aquadex FlexFlow System 2.0, to remove excess intravascular volume in hospitalized patients with decompensated (acute) heart failure and marked volume overload refractory to medical therapy (including diuretics), for adults and pediatric patients weighing ≥20 kg. Therapy is limited to inpatient settings under physician supervision, restricted to diuretic‑resistant cases with duration limits (temporary ≤8 hours; extended >8 hours only while hospitalized), excludes patients on dialysis or weighing <20 kg, and is considered investigational/experimental with insufficient evidence on optimal selection, delivery parameters, complication prevention, and cost‑effectiveness.

"Use of ultrafiltration (aquapheresis) to remove intravascular fluid in hospitalized patients with marked volume overload from decompensated heart failure, particularly when refractory to convention..."