On January 13, 2025, the Centers for Medicare and Medicaid Services (CMS) issued a National Coverage Determination to cover implantable pulmonary artery pressure sensors (IPAPS) for heart failure management under Coverage with Evidence Development (CED).
The CardioMEMS™ HF System CED study is now approved by CMS for the IPAPS NCD. This means all Medicare beneficiaries, including previously denied Medicare Advantage patients, will have access to the CardioMEMS HF System when policy criteria of NCD is met.
For Medicare and Medicare Advantage patients implanted with the CardioMEMS HF System, it is important to include the Clinical Trial Number 06779552 and all CED requirements on all medical necessity documentation to meet coverage requirements under this NCD.
Access these Abbott resources to prepare for the expanded coverage of the CardioMEMS HF System for your patients with heart failure.
Use this checklist to document patient details for insurance and procedure preparation.
Use these forms to help with billing claims for the CardioMEMS HF System.
This guide can help answer your questions about the NCD.
Access reimbursement resources for Coding and Coverage, Prior Authorization Management and Medicare.
Coverage with Evidence Development (CED) is a clinical study requirement to provide coverage. CED helps gather data to fill evidence gaps for certain medical items and services.
The CED protocol for the CardioMEMS HF System has been approved by CMS.
The NCT number is a unique identifier that enables real-world reporting for the CED. For Medicare and Medicare Advantage beneficieries receiving the CardioMEMS HF System, the NCT number is 06779552.
Read more about the CardioMEMS HF System CED study on ClinicalTrials.gov.
Physicians and implanting facilities must include study information, including the NCT number, on all claim forms to reduce risk of denial.
The NCD expands access to the CardioMEMS HF System for more heart failure patients. This means all Medicare beneficiaries, including previously denied Medicare Advantage patients, may have access to this technology if they meet NCD and CED criteria.
MAT-2500404 v2.0
Stay Connected