J1 MAC: Percutaneous Endovascular Cardiac Assist Covered

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  • July 26, 2012
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It isn’t every day a Medicare administrative contractor (MAC) says it will cover a procedure that has neither a specific CPT® code describing it nor any concrete proof that the medical intervention is even useful. On July 16, however, Palmetto GBA did exactly that when it posted a policy update for percutaneous endovascular cardiac assist procedures and devices.
Effective for dates of service on or after Sept. 1, 2011, the jurisdiction 1 Part B MAC will cover the percutaneous insertion of an endovascular cardiac assist device and the device itself.
Coverage will be allowed for (but not exclusively) the following ICD-9-CM codes:

  • Cardiogenic shock, reported with 785.51
  • Severe decompensated heart failure with threatening multi-organ failure, represented by one of the following:
    • 428.21 Acute systolic heart failure
    • 428.23 Acute or chronic systolic heart failure
    • 428.41 Acute combine systolic and diastolic heart failure
    • 428.43 Acute or chronic combined systolic and diastolic heart failure
    • 429.4 Functional disturbances following cardiac surgery
    • 997.1 Cardiac complications, not elsewhere classified

When submitting a claim to Palmetto for an endovascular cardiac assist procedure, report CPT® 33999 Unlisted procedure, cardiac surgery and enter “Impella” or “Tandem Heart” in item 19 of the CMS-1500 claim form or its electronic equivalent.
Source: Palmetto GBA

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No Responses to “J1 MAC: Percutaneous Endovascular Cardiac Assist Covered”

  1. Leslie Kehner says:

    If it is “Percutaneous”, wouldn’t you use the category III code 0048T?