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Coverage criteria policies

Heart failure pressure sensor, implantable (i.e., CardioMEMS HF System)

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not applicable for the heart failure pressure sensor, implantable (i.e., CardioMEMS HF System) because it is considered investigational/experimental. The provider and facility will be liable for payment unless:

  • The provider notifies the member that a specific service has been determined by HealthPartners to be investigational/experimental; and
  • The member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
  • The claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment

Coverage

The heart failure pressure sensor, implantable (i.e., CardioMEMS HF System) is considered investigational/experimental and is therefore not covered.

Definitions

The CardioMEMS HF System utilizes radiofrequency (RF) energy to power the sensor & to measure pulmonary artery (PA) pressure and consists of 3 components: a miniature, battery-free, leadless PA pressure sensor; a transvenous catheter to deliver and deploy the sensor within the distal PA; and an electronics system that acquires and processes signals from the implanted sensor and then transmits hemodynamic data, including systolic, diastolic, and mean PA pressure measurements, to a physician-accessible secure database. These measures allow the physician to proactively adjust HF treatments, hopefully avoiding a hospitalization. The device also monitors heart rate.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

C2624

Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components

C9741

Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report includes provision of patient home electronics unit

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. Abraham, W., Adamson, P., Bourge, R., Aaron, M., Costanzo, M., Stevenson, L., and Yadav, J. (2011) Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: A randomised controlled trial. The Lancet, 377 (9766); 658-666.
  2. Abraham, W., Adamson, P., Hasan, A., Bourge, R., Pamboukian, S., Aaron, M., and Raval, N. (2011) Safety and accuracy of a wireless pulmonary artery pressure monitoring system in patients with heart failure. American Heart Journal, 161(3); 558-566.
  3. Adamson, P., Abraham, W., Aaron, M., Aranda, J., Bourge, R., Smith, A. ...and Yadav, J. (2001) CHAMPIONTrial Rationale and Design: The Long-term Safety and Clinical Efficacy of a Wireless Pulmonary Artery Pressure Monitoring System. Journal of Cardiac Failure, 17 (1); 3-10.
  4. Adamson, P., Abraham, W., Bourge, R., Costanzo, M., Hasan, A., Yadav, C., …and Stevenson, L. (2014) Wireless Pulmonary Artery Pressure Monitoring Guides Management to Reduce Decompensation in Heart Failure With Preserved Ejection Fraction. Circ ulation: Heart Failure. 7(6); 935-44.
  5. ECRI Institute. (2016). ECRI Health Technology Assessment. Wireless implantable hemodynamic device (CardioMEMS HF System) for monitoring pulmonary artery pressure in heart failure. Plymouth Meeting, PA. ECRI Institute.
  6. ECRI Institute. (2014) ECRI Health Technology Forecast. Implantable intracardiac pressure monitors for managing HF. Plymouth Meeting, PA. ECRI Institute
  7. ECRI Institute. (2014). Custom Product Briefs-Guidance: CardioMEMS HF System (St. Jude Medical) for Wireless Monitoring of Pulmonary Artery Pressure in Patients with Heart Failure. Plymouth Meeting, PA: ECRI Institute.
  8. Hayes, Inc. Search & Summary. CardioMEMS HF System (St. Jude Medical) for Management of Chronic Heart Failure. Lansdale, PA: Hayes, Inc.; Jan, 2015. Hayes, Inc. Hayes Brief. Wireless Pulmonary Artery Pressure Monitoring with CardioMEMS HF System (St. Jude Medical Inc.) for Management of Chronic Heart Failure. Lansdale, PA: Hayes, Inc.; November, 2016.
  9. Horwitz, L. and Krumholz, H. Strategies to reduce hospitalization in patients with heart failure. In: UpToDate, Hunt, S (Ed), UpToDate, Waltham, MA (Accessed on July 28, 2017).
  10. Loh, J., Barbash, I. and Waksman, R. (2011) Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the CardioMEMS Champion Heart Failure Monitoring System. Journal of the American College of Cardiology. 61(15); 1571-1576.
  11. Verdejo, H., Castro, P., Concepcion, R., Ferrada, M., Alfaro, M., Alcaino, M. …and Bourge, R. (2007) Comparison of a Radiofrequency-Based Wireless Pressure Sensor to Swan-Ganz Catheter and Echocardiography for Ambulatory Assessment of Pulmonary Artery Pressure in Heart Failure. Journal of the American College of Cardiology. 50(25); 2375-2382.

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Policy activity

  • 09/24/2015 - Date of origin
  • 09/24/2015 - Effective date
Review date
  • 09/2017

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