Transcatheter Mitral Valve Repair (TMVR)

Effective for claims with dates of service furnished on or after August 7, 2014, the Centers for Medicare & Medicaid Services (CMS) will reimburse claims for TMVR for Mitral Regurgitation (MR) when furnished under Coverage with Evidence Development (CED).

TMVR is non-covered for the treatment of MR when not furnished under CED according to the above-noted criteria. TMVR used for the treatment of any non-MR indications are non-covered by Medicare.

CPT Codes And Coding Requirements For TMVR For MR Claims

The Current Procedural Terminology (CPT) Codes for TMVR for MR Claims are:

CPT 0343T – Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; initial prosthesis. (Note: CPT 0343T will be replaced by CPT code 33418 effective January 1, 2015.)

CPT 0344T – Transcatheter mitral valve repair percutaneous approach including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure). (Note: CPT 0344T will be replaced by CPT code 33419 effective January 1, 2015.

CPT 0345T – Transcatheter mitral valve repair percutaneous approach via the coronary sinus

CPT 33418 – Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis. (Note: CPT code 33418 is effective January 1, 2015.)

CPT 33419 – Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session. (List separately in addition to code for primary procedure.) (Note: CPT code 33419 is effective January 1, 2015.)

Professional Claims Place Of Service (POS) Codes For TMVR For MR Claims

Place of service (POS) code 21 is valid for use for TMVR for MR services. All other POS codes will be denied.

MACs will supply the following messages when MACs denying TMVR for MR claims for invalid POS:

Claim Adjustment Reason Code (CARC) 58: “Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.”

Group Code CO (Contractual Obligation) assigning financial liability to the provider (if a claim is received with a GZ modifier indicating no signed Advance Beneficiary Notice (ABN) is on file.)

Professional Claims Modifiers For TMVR For MR Claims

MACs will pay TMVR for MR claim lines billed with CPT codes 0343T, CPT 0344T, and CPT 00345T when billed for two surgeons/co-surgeons only when the claim includes modifier -62. (Effective January 1, 2015, CPT codes 33418 and CPT 33419 replace CPT codes 0343T and CPT 0344T, respectively.)

Claim lines for two surgeons/co-surgeons billed without modifier -62 shall be returned as unprocessable.

Effective for claims with dates of service on or after August 7, 2014, MACs will pay claim lines for TMVR for MR billed with CPT codes 0343T, CPT 0344T, and CPT 0345T in a clinical trial when billed with modifier Q0. (Effective January 1, 2015, CPT codes 33418 and CPT 33419 replace CPT codes 0343T and CPT 0344T, respectively.) TMVR for MR claim lines in a clinical trial billed without modifier -Q0 will be returned as unprocessable.