Transcatheter Tricuspid Valve Repair or Replacement

This policy covers transcatheter tricuspid edge‑to‑edge repair (T‑TEER) and transcatheter tricuspid valve replacement (TTVR) with FDA‑approved devices for patients with severe tricuspid regurgitation who remain symptomatic despite maximally tolerated guideline‑directed medical therapy and are judged by a multidisciplinary heart team to be intermediate‑ or high‑risk for open surgery. Coverage is limited to FDA‑approved devices for anatomically suitable patients who can tolerate antiplatelet and anticoagulant therapy and meet imaging and heart‑team selection criteria; procedures are excluded for nonsevere TR, surgical candidates, or patients with contraindications (e.g., active endocarditis, device‑material or contrast allergies, inability to undergo required imaging or to take antiplatelet/anticoagulant agents) and for non–FDA‑approved or investigational devices.

"Transcatheter tricuspid edge-to-edge repair (T-TEER) with an FDA‑approved device for individuals with severe tricuspid regurgitation (TR) despite maximally tolerated guideline‑directed medical ther..."