CARDIOVASCULAR
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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 central 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:

Mechanical Circulatory Support (MCS) Coding Guide

This Medicare coding and payment guide covers the HeartMate 3 LVAS and other mechanical circulatory support products.

Abbott Coverage and Frequently Asked Questions (FAQs) Guide: Mechanical Circulatory Support

This guide provides coverage and reimbursement information for the implantable HeartMate 3 Left Ventricular Assist Device (LVAD) and other procedures.

HCPCS Device Category C-codes

This link offers a current list of reimbursement Healthcare Procedural Coding System Device Category C-codes.

Common CPT Code Modifiers

This printable form offers easy CPT coding references.

Webinars

2020 Mechanical Circulatory Support Medicare Payment update focused on HeartMate Left Ventricular Assist Devices and CentriMag™ Acute Circulatory Support System

Registration is required for this webinar, which addresses the FY 2020 Medicare Inpatient Prospective Payment System (IPPS), CY 2020 Medicare Physician Fee Schedule (PFS) payment and policy updates for HeartMate LVAD and CentriMag System devices.

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.

Centers for Medicare and Medicaid Services (CMS)

CMS Physician Fee Schedule Prospectus

This guide includes Medicare Physician Payment Rates for cardiovascular procedures. For more detailed information, please refer to the CY Physician Fee Schedule Final Rule on the CMS website.

CMS Inpatient Reimbursement Prospectus

This guide provides a summary of the Medicare Hospital Inpatient Prospective Payment System (IPPS). It includes information on the Readmission Reductions Program, Value Based Purchasing, and Hospital Inpatient Reimbursement Rates for select cardiovascular DRGs. For more detailed information, please refer to the FY IPPS Final Rule on the CMS website.

CMS Outpatient Reimbursement Prospectus

This guide provides a summary of the Medicare Hospital Outpatient Prospective Payment System (OPPS) Update. It includes updates to the Comprehensive APC Policy, Site Neutral Payments, Device Intensive Procedures, the Transitional Pass-Through Payment Policy and Hospital Outpatient Reimbursement Rates for select cardiovascular APCs. For more detailed information, please refer to the CY OPPS Final Rule on the CMS website.

Medicare Local Coverage Determinations (LCDs)

In the absence of a national coverage policy, an item or service may be covered at a local basis. Check here for a list of CMS policies that provide Medicare beneficiaries coverage in certain locations across the country.

Medicare Learning Network (MLN) Matters Articles

Focusing on coverage, billing and payment rules for specific provider types, these articles explain national Medicare policy in an easy-to-understand format.

National Correct Coding Initiatives Edits

Developed by CMS, the National Coding Initiative promotes correct coding methodologies to control improper coding leading to inappropriate payment.

  • Manuals & Resources
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DO YOU WISH TO CONTINUE AND EXIT CARDIOVASCULAR.ABBOTT?

CONTENTS OF THE SITE ARE NOT UNDER THE CONTROL OF ABBOTT.