Ventricular Assist Devices and Total Artificial Hearts

This policy covers implantation and short‑term use of ventricular assist devices (implantable and percutaneous) and FDA‑approved total artificial hearts for post‑cardiotomy support, as bridges to heart transplantation (including specified pediatric bridge‑to‑transplant indications) and for selected adult destination therapy, and authorizes FDA‑approved pVADs for short‑term cardiogenic shock or as adjuncts in high‑risk PCI. Coverage requires FDA approval/clearance (including HDE where specified), meeting strict clinical thresholds (e.g., NYHA III–IV, LVEF ≤25%, inotrope dependence or low cardiac index), is device‑ and indication‑specific (total artificial hearts limited to biventricular failure and not covered as destination therapy; only DeBakey VAD Child and Berlin Heart EXCOR are approved for pediatrics), and non‑approved uses or xenotransplantation are considered experimental and not covered; member benefit plans and state rules govern final coverage.