CMS Expands MitraClip Coverage by Medicare : vimarsana.com

CMS Expands MitraClip Coverage by Medicare


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Medicare reimbursement for transcatheter mitral valve repair (TMVR) was extended to include secondary (functional) mitral regurgitation resulting from heart failure, according to a revised National Coverage Determination (NCD).
The Centers for Medicare & Medicaid Services (CMS) renamed the TMVR NCD to cover "mitral valve Transcatheter Edge-to-Edge Repair" for people with secondary mitral regurgitation who remain symptomatic despite guideline-directed medical therapy.
Notably, registry participation continues to be required as part of the Coverage with Evidence Development (CED) policy.
This comes in response to considerable backlash on a draft proposal to remove the CED requirement in the new NCD. Public commenters also disagreed with the proposed plan to establish coverage for primary (degenerative) mitral regurgitation at the discretion of Medicare Administrative Contractors.

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