Our reimbursement resources provide information about coverage, coding and payment, denied claims and supporting documentation for the CardioMEMS™ HF System.
As of July 1st, 2020, Novitas Solutions, Inc. (NOVITAS) and First Coast Service Options, Inc. (FCSO) retired their local non-coverage policies (LCD L36419 and LCD L33777) for the CardioMEMS HF System. Novitas is the Medicare Administrative Contractor (MAC) that administers the Medicare claims for DE, MD, NJ, PA, DC, AR, CO, LA, MS, NM, OK and TX. FCSO is the MAC for FL, Puerto Rico, and the Virgin Islands.
For dates of service on and after July 1st, 2020, providers can provide pulmonary artery pressure sensor implant (CPT 33289) and remote monitoring services (CPT 93264) for appropriately indicated Medicare patients based on reasonable and medically necessary guidelines similar to the other Medicare contractors. This means that Novitas and FCSO will implicitly cover wireless pulmonary artery sensor implants and remote monitoring based on medical appropriateness and the FDA approved indication, and the claims processing edits for denying the aforementioned procedure codes will be removed. Providers should continue to document medical necessity of the CardioMEMS HF System for their patients.
As a breakthrough, first in-kind technology, the Centers for Medicare and Medicaid Services (CMS) granted the CardioMEMS HF System new technology payments for the inpatient and outpatient hospital settings. These payments recognized the CardioMEMS HF System as a substantial clinical improvement over previous standard of care.
Since these new technology payments have expired, CMS has established both inpatient and outpatient reimbursement mechanisms for the CardioMEMS HF System implant procedure. CMS also established hospital outpatient and office-based reimbursement of ongoing remote monitoring.
At a high level, it is important to note the following:
Please review the following reimbursement resources that provide physician and hospital coding and payment rates for the CardioMEMS HF System and the remote monitoring services provided after the implant. Additional resources and information available on the reimbursement page.
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-2205192 v1.0
Our regional, field-based Health Economics & Reimbursement (HE&R) team is available to assist with reimbursement education and coding, coverage and payment questions specific to the CardioMEMS HF System and other Abbott therapies and products.
To contact the HE&R team, please email or call the Reimbursement Hotline at (855) 569-6430
MAT-2006907 v4.0