Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)

CMS National Coverage Determination | ncd_id=267 | manual_section=20.16 | coverage_level_code=2 | national_coverage_type=True | under_review=True | lab_ncd=False

B. Nationally Covered Indications Effective for services performed on and after January 23, 2004, TEB is covered for the following uses: Differentiation of cardiogenic from pulmonary causes of acute dyspnea when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient. Optimization of atrioventricular (A/V) interval for patients with A/V sequential cardiac pacemakers when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient. Monitoring of continuous inotropic therapy for patients with terminal congestive heart failure, when those patients have chosen to die with comfort at home, or for patients waiting at home for a heart transplant. Evaluation for rejection in patients with a heart transplant as a predetermined alternative to a myocardial biopsy. Medical necessity must be documented should a biopsy be performed after TEB. Optimization of fluid management in patients with congestive heart failure when medical history, physical examination, and standard assessment tools provide insufficient information, and the treating physician has determined that TEB hemodynamic data are necessary for appropriate management of the patient. C. Nationally Non-Covered Indications 1. TEB is non-covered when used for patients: With proven or suspected disease involving severe regurgitation of the aorta; With minute ventilation (MV) sensor function pacemakers, since the device may adversely affect the functioning of that type of pacemaker; During cardiac bypass surgery; or, In the management of all forms of hypertension (with the exception of drug- resistant hypertension as outlined below). 2. All other uses of TEB not otherwise specified remain non-covered. D. Other Medicare Administrative Contractors have discretion to determine whether the use of TEB for the management of drug-resistant hypertension is reasonable and necessary. Drug resistant hypertension is defined as failure to achieve goal blood pressure in patients who are adhering to full doses of an appropriate 3-drug regimen that includes a diuretic. Effective November 24, 2006, after reconsideration of Medicare policy, CMS will continue current Medicare policy for TEB.