As of July 1st 2020, Novitas Solutions, Inc (Novitas) and First Coast Services Options, Inc (FCSO) have retired their non-coverage Local Coverage Determination (LCD).

Novitas and FCSO recently retired their long-standing local non-coverage policies for the CardioMEMS™ Heart Failure (HF) System. Novitas is the Medicare Administrative Contractor (MAC) that administers the Medicare claims for Delaware, Maryland, New Jersey, Pennsylvania, District of Columbia, Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas. FCSO is the MAC for Florida, Puerto Rico, and the Virgin Islands.

Patients in these two Medicare Contractor jurisdictions now have access and implicit coverage to the CardioMEMS HF System based on reasonable and medically necessary guidelines for dates of service on and after July 1st, 2020.

Coding for Pulmonary Artery (PA) pressure monitoring with the CardioMEMS HF System

What you should know

• Providers can provide pulmonary artery pressure sensor implants (CPT 33289) and remote monitoring services (CPT 93264) for appropriately indicated Medicare patients based on reasonable and medically necessary guidelines.
• The retirement of these LCDs implicitly allows coverage for these jurisdictions who were previously restricted and provides access for Medicare patients consistent with other contractors.
• Providers should continue to document medical necessity for their patients.
• We continue to encourage providers seek prior authorization for Medicare Advantage plans as they may have their own medical policies in the absence of a defined Medicare LCD or national coverage determination (NCD).
• This milestone represents an opportunity in supporting and managing our chronic heart failure patients to prevent future hospitalizations during the COVID-19 pandemic.

Indications, Safety & Warnings

Rx Only

Brief Summary: Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, potential adverse events and directions for use.

CardioMEMS™ HF System Indications and Usage: The CardioMEMS™ HF System is indicated for wirelessly measuring and monitoring pulmonary artery (PA) pressure and heart rate in New York Heart Association (NYHA) Class III heart failure patients who have been hospitalized for heart failure in the previous year. The hemodynamic data are used by physicians for heart failure management and with the goal of reducing heart failure hospitalizations.

CardioMEMS™ HF System Contraindications: The CardioMEMS™ HF System is contraindicated for patients with an inability to take dual antiplatelet or anticoagulants for one-month post implant.

CardioMEMS™ HF System Potential Adverse Events: Potential adverse events associated with the implantation procedure include, but are not limited to the following: Infection, Arrhythmias, Bleeding, Hematoma, Thrombus, Myocardial infarction, Transient ischemic attack, Stroke, Death and Device embolization. Refer to the User’s Manual for detailed indications, contraindications, warnings, precautions and potential adverse events.