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Transcatheter Heart Valve Procedures Corporate Medical Policy Effective July 15

Audience: Cardiology Providers

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment here. Providers now have the capability of attaching supporting documentation related to their comments.
The following medical policy has been reviewed and was approved on March 24, 2022, by the Corporate Medical Policy Committee, including practitioner representatives from all Health Plan regions. The policy is effective July 15, 2022.

The new corporate medical policy listed below merges CMP# 7.01.107 Transcatheter Aortic Valve Implantation for Aortic Stenosis and CMP# 7.01.108 Transcatheter Mitral Valve Repair and adds policy criteria for the procedures of transcatheter pulmonary valve implantation and transcatheter tricuspid valve repair or replacement. The policy applies to the services of all practitioners and facilities. The policy does not apply to all lines business. Benefits are contract dependent. Please refer to the medical policy and the member’s subscriber contract.

CMP# 7.01.109 – Transcatheter Heart Valve Procedures

  • Transcatheter tricuspid valve repair or replacement is considered investigational.
  • Transcatheter placement and removal of a cerebral embolic protection device is considered investigational.

The rationale section of the medical policy provides information related to the Health Plan’s coverage criteria. These services are subject to audit and policy updates at the Health Plan’s discretion. These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies here.

If you have any questions regarding this policy, please contact your Provider Relations representative.

Thank you for the quality of care and service that you provide to our members.

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