Transcatheter Mitral Valve Procedures

This policy covers transcatheter mitral valve procedures — including transcatheter mitral valve repair (e.g., MitraClip™, PASCAL™) and transcatheter mitral valve‑in‑valve replacement (TMViVR) — when performed with U.S. FDA‑approved devices. Coverage is limited to symptomatic patients with primary (degenerative) MR who are prohibitive/high surgical risk (e.g., STS predicted mortality ≥12% or logistic EuroSCORE ≥20%, or heart‑team judgment), symptomatic secondary (functional) MR despite maximally tolerated guideline‑directed medical therapy with echocardiographic MR ≥3+ and appropriate NYHA class, or failing surgical bioprosthetic mitral valves at high/repeat‑surgery risk; procedures are not covered for asymptomatic patients or indications outside these specified criteria and investigational devices/techniques.

"Transcatheter mitral valve repair (coverage section titled 'Transcatheter Mitral Valve Repair' present)"