Reimbursement and Coding for the HeartMate 3 LVAD | Abbott
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Reimbursement & Coding

National Coverage Determination for Ventricular Assist Devices

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.

Coding Guides and Resources

Mechanical Circulatory Support (MCS) Coding Guide

Medicare coding and payment guide for for the HeartMate II™ LVAS, HeartMate 3™ LVAS and other mechanical circulatory support products

Mechanical Circulatory Support (MCS) FAQ Guide

HCPCS Device Category C-codes

Current list of reimbursement Healthcare Procedural Coding System (HCPCS) Device Category C-codes

Webinars

2022 Mechanical Circulatory Support (MCS) Medicare Payment update focused on HeartMate™ Left Ventricular Assist Devices (LVAD)

This webcast reviews major milestones from 2021 and addresses the FY 2022 Medicare Inpatient Prospective Payment System (IPPS), CY 2022 Medicare Physician Fee Schedule (PFS) payment and policy updates for HeartMate™ LVAD.

National Coverage Determinations From Medicare and Medicaid

National Coverage Determination (NCD) for Ventricular Assist Devices

Developed through an evidence-based process, this policy provides details on required medical criteria that must be met for coverage of Medicare beneficiaries.

Cardiac Catheterization Performed in Other Than a Hospital Setting

Provides Medicare guidance on coverage when the procedure is performed in a location other than a hospital.

HE&R Disclaimer

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.

MAT-2207255 v1.0

  • Manuals & Resources
    Manuals & Resources
  • Find a HeartMate 3 LVAD Center
    Find a HeartMate 3 LVAD Center
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    Customer Service
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DO YOU WISH TO CONTINUE AND EXIT CARDIOVASCULAR.ABBOTT?

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