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Medicare Coverage for Transcatheter Aortic Valve Replacement (TAVR)


Transcatheter aortic valve replacement (TAVR - also known as TAVI or transcatheter aortic valve implantation) is a new technology for use in treating aortic stenosis. A bioprosthetic valve is inserted percutaneously using a catheter and implanted in the orifice of the native aortic valve.

CPT Codes to report Transcatheter Aortic Valve Replacement (TAVR)

0256T – Implantation of catheter-delivered prosthetic heart valve, endovascular approach

0257T – Implantation of catheter-delivered prosthetic heart valve, open thoracic approach (e.g., transapical, transventricular)

The following add-on codes are for use with 0257T only:

0258T – Transthoracic cardiac exposure for catheter-delivered aortic valve replacement; without cardiopulmonary bypass.

0259T – Transthoracic cardiac exposure for catheter-delivered aortic valve replacement; with cardiopulmonary bypass.

ICD-9-CM Diagnosis Code - Physician Coding

424.1 – Aortic valve disorders

ICD-9-CM Procedure Codes - Hospital Coding

35.05 – Endovascular replacement of aortic valve

35.06 – Transapical replacement of aortic valve

Modifiers

Use of modifier 62 is appropriate if co-surgeons (e.g., interventional cardiologist and cardiothoracic surgeon) accomplished the procedure. Medicare co-surgery requirements will be applied. The operative report must clearly substantiate the activities of both physicians.

Use of assistant surgeon modifiers 80 and/or 82 are appropriate if an assistant participated in the procedure. Medicare assistant surgeon requirements will be applied. The operative report must clearly substantiate the activities of both the surgeon and the assistant surgeon.

Please note: Payment for hospitals is based on DRG assignment. As zero-day global will apply, physicians should bill separately for postoperative care.

For more information: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Transcatheter%20Aortic%20Valve%20Replacement%20%28TAVR%29&bc=AiAAAAAAIAAA&NCAId=257&

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