Does L8698 require prior authorization?

No, L8698 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L8698`, Miscellaneous component, supply or accessory for use with total artificial

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For prolonged extracorporeal percutaneous transseptal VAD procedures, report using CPT 33999 (unlisted procedure, cardiac surgery) per the policy note.

Implantable VADs with FDA approval or clearance may be considered medically necessary as a bridge to heart transplantation for individuals listed as candidates and not expected to survive to donor or those undergoing evaluation for candidacy.
Implantable ventricular assist devices that have FDA PMA, 510(k), or HDE clearance are considered medically necessary when used for one of the listed indications (items 1–3).
VAD as a bridge to transplantation is medically necessary when the patient is currently listed (or undergoing evaluation) as a heart transplant candidate AND is not expected to survive until a donor heart is available.
VAD use is medically necessary in the post-cardiotomy setting for patients who cannot be weaned from cardiopulmonary bypass.
VAD as destination therapy is medically necessary only when ALL of the following are met: end-stage heart failure; NYHA Class III with dyspnea on mild activity or NYHA Class IV; LVEF ≤25%; (a) inotrope-dependent OR (b) cardiac index <2.2 L/min/m2 while not on inotropes; AND (i) failed optimal medical management including beta-blocker/ACE inhibitor for ≥45 of last 60 days OR (ii) advanced HF ≥14 days and dependent on intra-aortic balloon pump ≥7 days.

BCBSIL-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts

BCBSMT-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts

BCBSNM-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts

BCBSOK-SUR707.017, Ventricular Assist Devices and Total Artificial Hearts

REGENCE-SUR52, Ventricular Assist Devices and Total Artificial Hearts