Find reimbursement resources, including coding guides, links to Medicare Coverage Determinations, on-demand webinars, and frequently asked questions for pulmonary artery pressure monitoring.
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 CardioMEMS for their patients.
If you need further assistance, connect with our Patient Therapy Access Team by phone or email: +1-800-727-7846
Abbott offers the Prior Authorization and Appeals templates for use by providers when seeking prior authorization or appealing denials of coverage. The objective of these resources is to provide assistance in submitting individual coverage consideration for appropriately indicated patients who may benefit from implantation of a pulmonary sensor device for remote hemodynamic monitoring of heart failure. Download the templates using the links below to customize and provide medical justification for consideration of this procedure.
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.