Reimbursement and Coding

• LAAC-PFO Structural Interventions Coding Guide

  Medicare coding and payment guide for Left Atrial Appendage Closure and Patent Foramen Ovale

• Structural Heart and Valves Coding Guide

  Medicare coding and payment guide for transcatheter occluders and surgical heart valves

• Amplatzer Piccolo™ Occluder Coding and Reimbursement Guide

  Medicare coding and payment guide for Patent Ductus Arteriosus (PDA) closure procedures

Abbott offers this Prior Authorization and appeal Tool Kit for use by physicians and their offices when seeking prior authorization or appealing denials of coverage. This comprehensive tool kit includes information to assist your office in submitting coverage requests for patients who may benefit from a LAA or PFO closure procedure. Download the guides and the accompanying templates using the links below.

• Tool Kit Instructions

  Download this guide for submitting prior authorization requests for your patients. It includes instructions on how to use this tool kit and the associated forms.

• LAAC Letter of Appeal

  Download a sample letter template that provides suggestions to assist in writing a Letter of Appeal of a denial of coverage for LAAC device implant procedures. Physicians should customize the letter based on the patient's actual medical history and diagnosis, and to be consistent with any specific appeal requirements.

• LAAC Letter of Medical Necessity

  Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for LAAC device implant. Physicians should customize the letter based on the patient's actual medical history and diagnosis and to be consistent with any specific prior authorization requirements.

• LAAC Prior Authorization Checklist

  Checklist provided as a summary of the information used to process Prior Authorization Requests for Left Atrial Appendage Closure (LAAC) Intervention procedures.

• Clinical Documentation Checklist: Diagnosis of Cryptogenic Ischemic Stroke

  Download this checklist for submitting prior authorization requests for your patient. The checklist includes a list of assessments recommended in the latest professional society guidelines for diagnosing a cryptogenic ischemic stroke.

• PFO Letter of Medical Necessity

  Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific prior authorization requirements.

• PFO Letter of Appeal

  Download a sample letter template that provides suggestions to assist in writing a Letter of Appeal of a denial of coverage for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific appeal requirements.

*This Tool kit provides suggested instruction and summary of guidelines for facilitating prior authorization or appeal requirements. It is not an endorsed resource of any benefit provider as providers are highly encouraged to review each benefit provider's policy and requirements for prior authorization and medical guidelines.

• LAAC National Coverage Determination

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

• CMS Physician Fee Schedule Information

  This link provides information on the CMS CY Physician Fee Schedule Final Rule.

• CMS Inpatient Reimbursement Information

  This link provides a summary of the Medicare Hospital Inpatient Prospective Payment System (IPPS). It includes information on the Readmissions Reduction Program, Value Based Purchasing, and Hospital Inpatient Reimbursement Rates. For more detailed information, please refer to the FY IPPS Final Rule on the CMS website.

• CMS Outpatient Reimbursement Information

  This link provides a summary of the Medicare Hospital Outpatient Prospective Payment System (OPPS) and information on the Hospital Outpatient Reimbursement Rates. For more detailed information, please refer to the CY OPPS Final Rule on the CMS website.