On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) updated the final decision memo for National Coverage Determination (NCD 20.9.1) for Ventricular Assist Devices.
CMS removed the pre-implant designations (bridge-to-transplant and destination therapy) in favor of clinical criteria for qualification of VADs for the purpose of coverage and payment effective for dates of services on and after December 1, 2020.
To access the final decision memo and the analysis in its entirety please go to cms.gov.
Access coding documents, health care economics insights, FAQs and other educational references for HeartMate 3™ LVAS and other mechanical circulatory support products.
This document and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.
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