About this policy
CMS National Coverage Determination | ncd_id=122 | manual_section=20.26 | coverage_level_code=3 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Since the mortality rate is high and there are no published scientific articles or clinical studies regarding partial ventriculectomy, this procedure cannot be considered reasonable and necessary within the meaning of §1862(a)(1) of the Act. Therefore, partial ventriculectomy is not covered by Medicare.
Documentation requirements
Item/Service Description: Partial ventriculectomy, also known as ventricular reduction, ventricular remodeling, or heart volume reduction surgery, was developed by a Brazilian surgeon and has been performed only on a limited basis in the United States. This procedure is performed on patients with enlarged hearts due to end-stage congestive heart failure. Partial ventriculectomy involves reducing the size of an enlarged heart by excising a portion of the left ventricular wall followed by repair of the defect. It is asserted that this procedure makes the failing heart pump better by improving the efficiency of the remaining left ventricle. Revision History: 03/1997 - Provided noncoverage policy. Effective date 04/15/1997. (TN 93) Benefit Categories: 52 - Physicians' Services Transmittal: transmittal_number=93 | transmittal_issue_date=1997-03-01
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
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