Transmyocardial Revascularization (TMR)

CMS covers transmyocardial revascularization (TMR) only as a late or last-resort therapy for patients with severe angina (CCS Class III or IV) refractory to maximal medical therapy when ischemic but viable myocardium cannot be revascularized by direct coronary intervention. Coverage requires EF ≥25%, demonstration of non-revascularizable viable myocardium, patient stabilization (or maximal stabilization efforts), use of an FDA‑approved laser for the intended purpose, and performance by trained physicians at facilities with dedicated cardiac units and ANSI-compliant laser safety.

"Severe angina, Canadian Cardiovascular Society (CCS) Class III or IV (stable or unstable), refractory to standard medical therapy including drug therapy at maximum tolerated or maximum safe dosages."

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