Does Q0487 require prior authorization?

No, Q0487 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for Q0487?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`Q0487`, Leads (pneumatic/electrical) for use with any type electric/pneumatic

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Serial blood and urine testing may be used to verify abstinence from substances of concern.
Documented assessment of substance use and either objective evidence of abstinence/risk‑reduction behaviors or a documented commitment to reduce behaviors when urgent transplant timelines apply.

Documentation of malignancy prognosis and evaluations supporting the absence of life‑limiting cancer within five years, and documentation of severity of renal, hepatic, or pulmonary dysfunction when applicable.

Key Coverage Criteria

VAD use when the heart is too weak to pump adequate blood to the body (support for severe heart failure or poor cardiac output).
Temporary use as a bridge to transplant to sustain a patient until heart transplantation can be performed.
Temporary use as a bridge to recovery, including as an adjunctive device in high‑risk percutaneous coronary interventions.
Use as a replacement for a damaged or diseased heart when mechanical circulatory support is required.
Short-term mechanical circulatory support as bridge to recovery for myocardial infarction complicated by cardiogenic shock.
Short-term mechanical circulatory support as bridge to recovery for high-risk percutaneous coronary interventions (PCI).

5 Active Policies

AMBETTER-CP.MP.46, Ventricular Assist Devices

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

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Q0487, Leads (pneumatic/electrical) for use with any type electric/pneumatic