The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

If you have any questions, please contact your carrier or A/B MAC at their toll-free number, which maybe found at http://www.cms.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMSweb site.DisclaimerThis article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links tostatutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of eitherthe written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statementof their contents. CPT only copyright 2009 American Medical Association.Ventricular Assist Devices as Destination TherapyMLN Matters® Number: MM7220 RevisedRelated Change Request (CR) #: 7220Related CR Release Date: December 8, 2010Effective Date: November 9, 2010Related CR Transmittal #: R129NCDImplementation Date: January 6, 2011Note: This article was revised on December 9, 2010 to reflect the revised CR 7220 released on December 8,2010. The CR release date, transmittal number, and the Web address for accessing CR were revised. Allother information is the same.Provider Types AffectedThis article is for physicians, providers, and suppliers submitting claims to Medicare contractors (carriers,fiscal intermediaries [FIs], and/or A/B Medicare administrative contractors [A/B MACs]) for ventricularassist device (VAD) implantation services provided to Medicare beneficiaries.What You Need to KnowEffective for claims with dates of service on or after November 19, 2010, the Centers for Medicare &Medicaid Services (CMS) has expanded coverage for VAD implantation as destination therapy asreasonable and necessary when the device has received Food and Drug Administration (FDA) approvalfor a destination therapy indication and only for patients with New York Heart Association (NYHA)Class IV end-stage ventricular heart failure who are not candidates for a heart transplant and who meetall specific conditions as outlined in the revised CMS Internet-Only (IOM) Publication 100-03, MedicareNational Coverage Determinations (NCD) Manual, Chapter 1, Section 20.9.BackgroundA VAD or left ventricular assist device (LVAD) is surgically attached to one or both intact ventricles andis used to assist a damaged or weakened native heart in pumping blood. Medicare currently covers thesedevices for three general indications:1. Postcardiotomy,2. Bridge to transplantation, and3. Destination therapy.Destination therapy is for patients who are not candidates for heart transplantation and requirepermanent mechanical cardiac support. Coverage for destination therapy is currently restricted based onpatient selection criteria including:• New York Heart Association (NYHA) class,• Time on optimal medical management,• Left ventricular ejection fraction, andCPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 54 MMR 2011-01, January 2011