Notification



Notification Issue Date:



Medicare Advantage Policy

Title:Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)
Policy #:MA11.027c

This policy is applicable to the Company’s Medicare Advantage products only. Policies that are applicable to the Company’s commercial products are accessible via a separate commercial policy database.


The Company makes decisions on coverage based on the Centers for Medicare and Medicaid Services (CMS) regulations and guidance, benefit plan documents and contracts, and the member’s medical history and condition. If CMS does not have a position addressing a service, the Company makes decisions based on Company Policy Bulletins. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable. Although the Medicare Advantage Policy Bulletin is consistent with Medicare’s regulations and guidance, the Company’s payment methodology may differ from Medicare.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.


This Policy Bulletin document describes the status of CMS coverage, medical terminology, and/or benefit plan documents and contracts at the time the document was developed. This Policy Bulletin will be reviewed regularly and be updated as Medicare changes their regulations and guidance, scientific and medical literature becomes available, and/or the benefit plan documents and/or contracts are changed.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's Evidence of Coverage.

TRANSCATHETER AORTIC VALVE REPLACEMENT

EXPERIMENTAL/INVESTIGATIONAL
In accordance with Medicare, transcatheter aortic valve replacement (TAVR) is considered experimental/investigational and, therefore, not covered, with the exception of Coverage with Evidence Development (CED).

COVERAGE WITH EVIDENCE DEVELOPMENT (CED)
FDA-Approved Indications

TAVR is eligible for coverage consideration for the treatment of symptomatic aortic valve stenosis when ALL of the following conditions are met:
  • The procedure is furnished with a complete aortic valve and implantation system that has received FDA premarket approval (PMA) for that system's FDA-approved indication.
  • Two cardiac surgeons have independently examined the individual face-to-face and evaluated the individual's suitability for open aortic valve replacement (AVR) surgery, and both surgeons have documented the rationale for their clinical judgment and the rationale is available to the Heart Team (The Heart Team is a cohesive, multi-disciplinary team of medical professionals. The heart team concept embodies collaboration and dedication across medical specialties to offer optimal individual-centered care).
  • The individual, preoperatively and postoperatively, is under the care of a Heart Team.
  • The professional and facility providers meet ALL the requirements as stated in the Centers for Medicare & Medicaid Services (CMS) decision memo for transcatheter aortic valve replacement (TAVR) (CAG-00430N).

Claims for TAVR for individuals enrolled in a CED clinical trial should be submitted to the Medicare Advantage plan.

Not Expressly Listed as FDA-Approved Indications

TAVR is eligible for coverage consideration for uses not expressly listed as FDA-approved indications when performed within a clinical study that fulfills ALL the requirements as stated in the CMS decision memo for transcatheter aortic valve replacement (TAVR) (CAG-00430N). Within the clinical study, the Heart Team's interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TAVR.

For a clinical trial involving a Category A IDE, professional providers are responsible for checking the CMS Coverage Website to identify whether CMS (or its designated entity) has approved the study for purposes of Medicare coverage prior to billing for the routine costs of a clinical trial involving a Category A IDE device. If Original Medicare determined that the device did, in fact, meet the requirements of coverage, and the clinical trial is approved, the Medicare Advantage plan will be responsible for payment of the routine costs associated with the Category A IDE study. The Category A IDE device remains not covered.

For a clinical trial involving a Category B IDE, professional providers are responsible for checking the CMS Coverage Website to identify whether CMS (or its designated entity) has approved the study for purposes of Medicare coverage, prior to billing for the routine costs of a clinical trial and the Category B IDE device. If Original Medicare determined that the device did, in fact, meet the requirements of coverage, and the clinical trial is approved, the Medicare Advantage plan will be responsible for payment of the routine costs associated with a qualifying clinical trial and the category B IDE device.

TRANSCATHETER MITRAL VALVE REPAIR (TMVR)

EXPERIMENTAL/INVESTIGATIONAL
In accordance with Medicare, transcatheter mitral valve repair (TMVR) is considered experimental/investigational and, therefore, not covered, with the exception of Coverage with Evidence Development (CED).

COVERAGE WITH EVIDENCE DEVELOPMENT (CED)
FDA-Approved Indications

Transcatheter mitral valve repair (TMVR) is eligible for coverage consideration for the treatment of significant (MR ≥ 3+), symptomatic degenerative mitral regurgitation when ALL of the following conditions are met:
  • The procedure is furnished with a complete transcatheter mitral valve repair system that has received FDA premarket approval (PMA) for that system's FDA approved indication.
  • Both a cardiothoracic surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease have independently examined the individual face-to-face and evaluated the individual's suitability for mitral valve surgery and determination of prohibitive risk (i.e., STS predicted operative risk score of 12 percent or greater; or presence of a logistic EuroSCORE of 20 percent or greater), and both physicians have documented the rationale for their clinical judgment and the rationale is available to the Heart Team.
  • The individual, preoperatively and postoperatively, is under the care of a Heart Team.
  • The professional and facility providers meet ALL the requirements as stated in the CMS decision memo for transcatheter mitral valve repair (TMVR) (CAG-00438N).

Claims for TMVR for individuals enrolled in a CED clinical trial should be submitted to the Medicare Advantage plan.

Not Expressly Listed as FDA-Approved Indications

TMVR is eligible for coverage consideration for uses that are not expressly listed as an FDA-approved indication when performed within an FDA-approved clinical study that fulfills ALL the requirements as stated in the CMS decision memo for transcatheter mitral valve repair (TMVR) (CAG-00438N). Within the clinical study, the Heart Team's interventional cardiologist(s) and cardiac surgeon(s) must jointly participate in the intra-operative technical aspects of TMVR.

For a clinical trial involving a Category A Investigational Device Exemption (IDE), professional providers are responsible for checking the CMS Coverage Website to identify whether CMS (or its designated entity) has approved the study for purposes of Medicare coverage prior to billing for the routine costs of a clinical trial involving a Category A IDE device. If Original Medicare determined that the device did, in fact, meet the requirements of coverage, and the clinical trial is approved, the Medicare Advantage plan will be responsible for payment of the routine costs associated with the Category A IDE study. The Category A IDE device remains not covered.

For a clinical trial involving a Category B IDE, professional providers are responsible for checking the CMS Coverage Website to identify whether CMS (or its designated entity) has approved the study for purposes of Medicare coverage prior to billing for the routine costs of a clinical trial and the Category B IDE device. If Original Medicare determined that the device did, in fact, meet the requirements of coverage, and the clinical trial is approved, the Medicare Advantage plan will be responsible for payment of the routine costs associated with a qualifying clinical trial and the category B IDE device.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

BILLING REQUIREMENTS

Claims for TAVR and TMVR for individuals enrolled in a CED clinical trial should be submitted to the Medicare Advantage plan.

Providers must report Modifier Q0 with procedure code to represent investigational clinical service provided in a Centers for Medicare & Medicaid Services (CMS) approved clinical research study.
Policy Guidelines

This policy is consistent with Medicare’s coverage determination. The Company’s payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR) are covered under the medical benefits of the Company’s Medicare Advantage products when the criteria listed in this medical policy are met.

However, services that are identified in this policy as experimental/investigational are not eligible for coverage or reimbursement by the Company.

Benefits and coverage for routine costs associated with qualifying clinical trials for individuals enrolled in Medicare Advantage are administered by Original Medicare.

After Original Medicare has paid its share of the cost for these services, the Company will also pay for part of the costs.

COVERAGE WITH EVIDENCE DEVELOPMENT (CED)

A list of approved CEDS for TAVR and TMVR listed and maintained on the CMS website at:
https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/

INVESTIGATION DEVICE EXEMPTION (IDE)

A list of IDE studies meeting CMS’ standards for coverage are listed and maintained on the CMS Coverage website at: https://www.cms.gov/Medicare/Coverage/IDE/Approved-IDE-Studies.html.

Description

TRANSCATHETER AORTIC VALVE REPLACEMENT

Surgical aortic valve replacement (AVR) has been the gold standard for treatment in adults with severe symptomatic aortic stenosis (i.e., narrowing of the aortic valve opening). Until recently, surgical AVR has been the only effective treatment. The most common cause of aortic stenosis in adults is calcification of the valve. This calcification progresses from the base of the cusps to the leaflets, and eventually causes a reduction in both leaflet motion and the effective valve area. This calcific disease is similar to atherosclerosis. Rheumatic aortic stenosis disease, related to valvular infection, is less common. In young adults, congenital valve malformations are the more common cause for aortic stenosis.

Technologic advancements have allowed for the delivery of heart valves via catheter as an alternative to open surgical valve replacement. Transcatheter aortic valve replacement (TAVR) treats the stenotic heart valve by displacing and functionally replacing the native aortic valve with a bioprosthetic valve delivered on a catheter via a percutaneous transarterial approach through a peripheral artery (e.g., the femoral artery), a transaortic approach through a limited sternotomy, or a transapical approach through a limited lower thoracotomy. Currently, two transcatheter aortic valves have Food and Drug Administration (FDA) approval for the treatment of aortic stenosis. The Edwards SAPIEN Transcatheter Heart Valve System balloon-expandable valve and the self-expanding Medtronic CoreValve Transcatheter Aortic Valve Replacement System (Medtronic Inc. Minneapolis, MN).

On November 2, 2011 the Food and Drug Administration (FDA) approved the first TAVR device, the Edwards SAPIEN Transcatheter Heart Valve System for marketing in the United States based on the pivotal PARTNER (Placement of AoRtic TraNscathetER Valves) study which incorporated two parallel prospective, unblinded, randomized, active-treatment controlled, multi-center pivotal trials evaluating the safety and effectiveness of transcatheter aortic valve replacement, via transfemoral or transapical (Cohort A only) delivery, in a stratified population of high risk (Cohort A) or inoperable (Cohort B) individuals. The Edwards’ Sapien Transcatheter Heart Valve (THV) was approved for transfemoral delivery in individuals with severe symptomatic native aortic valve stenosis who have been determined by a cardiac surgeon to be inoperable for open aortic valve replacement and in whom existing co-morbidities would not preclude the expected benefit from correction of the aortic stenosis. The FDA approval includes a statement recommending specific training and experience for professional providers to use the device, as well as continued clinical study and data submission to the Society of Thoracic Surgeons (STS), American College of Cardiology (ACC), Transcatheter Valve Therapy (TVT) Registry.

TRANSCATHETER MITRAL VALVE REPAIR

Mitral regurgitation (MR) is the second most common valvular heart disease which can result from a heterogeneous set of disease processes that may affect one or more parts of the mitral valve complex. Mitral regurgitation is a common valvular heart disease that can result from either a primary structural abnormality of the mitral valve complex or a dilated left ventricle due to ischemic or dilated cardiomyopathy, which leads to secondary dilation of an anatomically normal mitral valve.

Mitral regurgitation is classified into degenerative and functional mitral valve disease. In degenerative mitral valve regurgitation, disease results from primary structural abnormality of the mitral valve complex. Common cause of degenerative mitral regurgitation (DMR) include MV prolapse syndrome with subsequent myxomatous degeneration, rheumatic heart disease, coronary artery disease, infective endocarditis and collagen vascular disease. In the function mitral regurgitation, the primary abnormality is dilated ventricle due to ischemic or dilated cardiomyopathy, which leads to secondary dilation of an anatomically normal mitral valve. The severity of MR is classified into mild, moderate, and severe disease on the basis of echocardiographic and/or angiographic findings (1+, 2+ and 3-4+ angiographic grade, respectively).

In individuals with multiple comorbidities, surgical therapy may be underutilized. To address the unmet need for less invasive mitral valve repair, transcatheter approaches have been presented as a potential alternative to surgical therapy for MR, particularly among individuals who face prohibitively high surgical risks due to their age and comorbidities.

The MitraClip® Delivery System (Abbott Vascular Menolo Park, CA) consists of implant catheters and the MitraClip® device. The device, which is typically percutaneously deployed, is a permanent implant that attaches to the mitral valve leaflets as a treatment for reducing MR with the intended outcomes to improve recovery of the heart from overwork, improve function and potentially halt the progression of heart failure. The procedure is performed under general anesthesia via echocardiographic and fluoroscopic guidance. The heart beats normally during the procedure, and heart-lung bypass support is generally not required. The MitralClip® Delivery System received FDA approval through the premarket approval process in October 14, 2013. The device received approval for treatment of significant symptomatic mitral regurgitation (MR >3+) due to primary abnormality of the mitral apparatus (DMR) in individuals who have been determined to be at prohibitive risk for mitral valve surgery by a heart team.

The evidence for the use of MitralClip® in individuals with severe symptomatic DMR who are considered at prohibitive risk for open surgery includes single-arm cohort studies. No RCTs have been published evaluating MitraClip in prohibitive surgical risk populations. The reported results from Endovascular Valve Edge-to-Edge Repair Study (EVEREST) II high risk registry (HRR) and Real World Expanded Multicenter Study of the MitraClip® System (REALISM) registry subset of prohibitive risk DMR individuals served as a basis for the FDA premarket approval. The EVEREST II studies included individuals from the EVEREST I feasibility study, EVEREST II RCT, the EVEREST II single arm HRR, and the REALISM Continued Access Protocol (CAP) registry that included high risk and non-high risk enrollment. From 2003-2012, 544 individuals with ≥ 3+ DMR were prospectively enrolled in EVEREST I, EVEREST II RCT, EVEREST II HRR registry and the REALISM CAP registry. Of these 544 individuals, 141 were chosen. The charts for these 141 individuals were retrospectively reviewed by a multidisciplinary team that included two experienced mitral valve surgeons and one experienced mitral valve cardiologist for what the authors defined as prohibitive risk. The team also included echocardiographers to assess MR severity. From this group of 141 individuals, 127 met the definition of prohibitive risk and had at least one year follow-up.

This cohort included 25 individuals from EVEREST II HRR, 98 from the REALISM CAP registry and four other individuals. This cohort of individuals had a mean age of 82 years, 87 percent New York Heart Association (NYHA) functional class III/IV, with STS score of 13.2 ± 7.3 percent. Comorbidities included congestive heart failure (125/127), coronary artery disease (95/125), cerebrovascular disease history (24/127), chronic obstructive pulmonary disease (40/127), and diabetes (38/127). Adverse events were adjudicated by an independent Clinical Events Committee.

In individuals who received the device, either one (44.1 percent) or two (51.2 percent) clips were implanted. Six individuals did not receive a device, with four of these failures due to technical reasons and the remaining two having complications during the procedure that included tamponade and hemodynamic instability. Despite being determined to be at prohibitive risk for surgery three individuals did have open surgery, with two of the three alive at one year. Adverse events at one year included 30 deaths (23.6 percent) as well as stroke (2.4 percent), renal failure (3.9 percent), bleeding complication (15.7 percent), vascular complication (7.1 percent), and gastrointestinal complication requiring surgery (2.4 percent). Most surviving individuals (82.9 percent) at one year had MR ≤ 2+ and were in NYHA functional class I or II. One year survival appeared to be better for individuals who had 1+ or 2+ MR at discharge versus those who had 3+ or 4+. Short Form-36 health survey scores improved and the authors reported that hospitalizations were reduced in individuals whose MR was reduced.

The authors stated that the data were limited in that it was not completely from a randomized trial, due to not having a control arm to randomize to (as medical therapy lacks a treatment role in DMR, and surgical options are not standard in prohibitive surgical risk individuals). Because the cohort was retrospectively identified, all analyses were post-hoc.

The authors concluded that MitraClip therapy is safe in individuals with severe, primary DMR for whom a Heart Team has determined that mitral valve surgery is associated with a prohibitive risk/benefit ratio. Transcatheter reduction of DMR in these individuals provides significant benefits including improvements in symptoms and functional status, a decrease in hospitalizations, and favorable left ventricular remodeling at one year.
References

Centers for Medicare & Medicaid Services (CMS). Coverage with Evidence Development Studies. [CMS Web site]. 06/05/2018. Available at:https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/index. Accessed November 05, 2019.

Centers for Medicare & Medicaid Services (CMS). Decision Memo for Transcatheter Aortic Valve Replacement (TAVR) (CAG-00430N). 05/01/2012. [CMS Web site]. Available at:http://www.cms.gov//medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=257. Accessed November 05, 2019.

Centers for Medicare & Medicaid Services (CMS). Final Decision MemoDecision Memo for Transcatheter Mitral Valve Repair (TMVR) (CAG-00438N). 8/7/2014.[CMS Web site]. Available at:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=363&ncdver=1&NCAId=273&NcaName=Transcatheter+Mitral+Valve+Repair+(TMVR)&ExpandComments=n&ncd_id=250.4&ncd_version=1&basket=ncd%25253A250.4%25253A1%25253ATreatment+of+Actinic+Keratosis+(AKs)&bc=gABAAAAACAAAAA%3d%3d&. Accessed
November 05, 2019.


Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Related to Investigational Device Exemption (IDE) Studies. Approved IDE studies. [CMS Web site]. 08/04/2015. Available at: https://www.cms.gov/Medicare/Coverage/IDE/Approved-IDE-Studies.html.
Accessed November 05, 2019.

Centers for Medicare & Medicaid Services (CMS). MLN Matters.National Coverage Determination (NCD): Transcatheter Aortic Valve Replacement (TAVR) Coding Update/Policy Clarification. MM8168. [CMS website]. 01/01/2013. Revised 08/31/2015. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8168.pdf Accessed November 05, 2019.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Transcatheter Aortic Valve Replacement (TAVR). 20.32. [CMS Web site]. 05/01/2012. Available at:
https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=355&ncdver=1&NCAId=257&ver=4&NcaName=Transcatheter+Aortic+Valve+Replacement+(TAVR)&bc=ACAAAAAACAAAAA%3D%3D& Accessed November 05, 2019.

Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). Transcatheter Mitral Valve Repair (TAVR). 20.33 [CMS Web site]. 08/07/2014. Available at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=363&ncdver=1&bc=AgAAQAAAAAAAAA%3D%3D&. Accessed November 05, 2019.

Clinical Trials.gov. Edwards cardioband tricuspid valve reconstruction early feasibility study. [Clinical Trials.gov Web site]. 12/27/2017. Available at: https://clinicaltrials.gov/ct2/show/NCT03382457. Accessed November 05, 2019.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Edwards SAPIEN Trancather Heart valve. 510(k) summary. [FDA Web site]. 11/02/2011. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf10/p100041a.pdf. Accessed November 05, 2019.

US Food and Drug Administration. Summary of Safety and Effectiveness for the Edwards SAPIEN Transcatheter Heart Valve (PMA P11021). [FDA Web site]. 10/1392012. Available at: https://www.accessdata.fda.gov/cdrh_docs/pdf11/P110021B.pdf. Accessed November 05, 2019.



Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

0345T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

I06.0 Rheumatic aortic stenosis

I06.2 Rheumatic aortic stenosis with insufficiency

I34.0 Nonrheumatic mitral (valve) insufficiency

I34.8 Other nonrheumatic mitral valve disorders

I35.0 Nonrheumatic aortic (valve) stenosis

I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency



HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A


Misc Code

Modifiers:

THE FOLLOWING MODIFIER MUST BE APPENDED TO 0345T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419 IN ORDER TO BE CONSIDERED FOR REIMBURSEMENT

Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study



Coding and Billing Requirements

Claims for TAVR, TMVR should be submitted to the Medicare Advantage plan.





Policy History

MA11.027c

12/18/2019The policy has been reviewed and reissued to communicate the Company’s continuing position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).
05/09/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).
08/30/2017The policy has been reviewed and reissued to communicate the Company’s continuing position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).
12/23/2016This version of the policy will become effective 12/23/2016.

Policy updated to communicate continued position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).

Policy criteria revised with removal of inoperable criteria for TAVR in accordance with Medicare

The following CPT code has been added to this policy: 33366 (medically necessary)

The following ICD-10 CM codes have been removed from this policy:

I05.0 Rheumatic mitral stenosis
I05.2 Rheumatic mitral stenosis with insufficiency
I34.2 Nonrheumatic mitral (valve) stenosis

The following ICD-10 CM code has been added to this policy: (medically necessary)

I34.8 Other nonrheumatic mitral valve disorders

The following Modifier has been removed from this policy:
63 Two Surgeons

MA11.027b
02/03/2016Policy updated to communicate continued position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).
12/23/2015This version of the policy will become effective 02/03/2016.

Policy updated to communicate continued position on Transcatheter Aortic-Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR).

MA11.027a
08/12/2015This is a coding update.
This policy has been identified for the CPT code update, effective 07/01/2015.
The following CPT code have been added to this policy: 33418, 33419.

MA11.027
01/01/2015This is a new policy.




Version Effective Date: 12/23/2016
Version Issued Date: 12/23/2016
Version Reissued Date: 12/18/2019