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Transcutaneous aortic valve replacement (TAVR)

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 will be used to determine your coverage.

Administrative process

Prior authorization is required for transcutaneous aortic valve replacement (TAVR).

TAVR is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

TAVR is covered for:

  1. Symptomatic native aortic valve stenosis;
  2. In a patient who is inoperable for open aortic valve replacement; and
  3. In whom existing co-morbidities would preclude the expected benefit from correction of the aortic stenosis.

Indications that are not covered

TAVR is not covered for any additional indications.

Transcutaneous aortic valve replacement / implantation (TAVR / TAVI) is a minimally invasive procedure to replace the aortic valve in the heart. It is done percutaneously rather than through open heart surgery. The percutaneous approach involves accessing the aortic valve through the femoral (groin) artery. A balloon catheter is threaded through the femoral artery to the heart and the stent with valve is inserted over the diseased native aortic valve. Edwards Sapien THV is the current FDA approved device for this procedure.

Stenosis is an abnormal narrowing in the blood vessel. To relate to the topic of this policy, the aortic valve area of the aorta, which is the largest artery in the body, is the area that has stenosis.

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.

33361 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous
femoral artery approach
33362 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral
artery approach
33363 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary
artery approach
33364 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac
artery approach
33365 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic
approach (eg, median sternotomy, mediastinotomy)
33366 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical
exposure (eg, left thoracotomy)

33367 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve;
cardiopulmonary bypass support with percutaneous peripheral arterial and venous
cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure)
33368 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve;
cardiopulmonary bypass support with open peripheral arterial and venous cannulation
(eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary
procedure)
33369 - Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve;
cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta,
right atrium, pulmonary artery) (List separately in addition to code for primary procedure)

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

References

  1. Hayes Prognosis Report. “ Edwards Sapien® Transcatheter Heart Valve (THV) for Percutaneous or Transapical Aortic Valve Implantation” Feb 8, 2012
  2. CMS NCA for TAVI. http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=257&fromdb=true
  3. Hayes News. “New initial guidelines for TAVR programs.” 3/5/12
  4. Reynolds et al. “Cost-effectiveness of TAVR compared with standard care among inoperable patients with severe aortic stenosis: Results from the placement of aortic Transcatheter valves (PARTNER) trial (cohort B).” Circulation 2012;125:1102-1109

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.