Start Using Cat. III Codes for TAVR Services
Since this past May, you’ve been able to report—and be paid for—transcatheter aortic valve replacement (TAVR) for Medicare patients. The Centers for Medicare & Medicaid Services (CMS) recently release instructions for how to meet specific requirements for this new national coverage determination (NCD).
When submitting claims for these services, providers should use the following temporary Category III CPT® codes:
- 0256T Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach
- 0257T Implantation of catheter-delivered prosthetic aortic heart valve; open thoracic approach (eg, transapical, transventricular)
- 0258T Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass
- 0259T Transthoracic cardiac exposure (eg, sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass
Beginning Jan. 1, 2013, CMS anticipates permanent CPT® Category I codes will replace these temporary codes, per MLN Matters® MM7897.
Medicare contractors will reimburse for TAVR under Coverage with Evidence Development (CED). Claims submitted to Medicare must also include ICD-9-CM secondary diagnosis code V70.0 Routine general medical examination at a health care facility (ICD-10-CM Z00.6 Encounter for examination for normal comparison and control in clinical research program) and diagnosis code V70.7 Examination of participant in clinical trial to signify CED participation.