Ventricular Assist Devices for Bridge-to-Transplant and Destination Therapy
This Change Request (CR) is effective for claims with dates of service on and after October 30, 2013; contractors shall pay claims for Ventricular Assisted Devices as destination
therapy using the criteria in Pub. 100-03, chapter 1, section 20.9.1, and Pub. 100-04, Chapter 32, sec. 320. This revision to the Medicare National Coverage Determinations Manual is a national coverage determination (NCD). NCDs are binding on all carriers, fiscal intermediaries, contractors with the Federal government that review and/or adjudicate claims, determinations, and/or decisions, quality improvement organizations, qualified independent contractors, the Medicare appeals council, and administrative law judges (ALJs) (see 42 CFR section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i) of the Social Security Act.)
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 29, 2014
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