Expanded Coverage for the CardioMEMS HF System

Expanded access for Medicare beneficiaries, including Medicare Advantage patients under a new National Coverage Determination.*

*If coverage criteria is met

Expanded Coverage for the CardioMEMS HF System

The CardioMEMS HF System is now covered under a National Coverage Determination (NCD)

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.
 

What You Need to Know

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.

Next Steps for Healthcare Providers

Access these Abbott resources to prepare for the expanded coverage of the CardioMEMS HF System for your patients with heart failure.

Clinical
Checklist

Use this checklist to document patient details for insurance and procedure preparation.

CardioMEMS checklist

Sample
Claim Forms

Use these forms to help with billing claims for the CardioMEMS HF System.
 

Sample Claim Forms

Frequently Asked Questions

This guide can help answer your questions about the NCD.
 

Is your patient indicated for CardioMEMS

Questions About the NCD? Contact the Abbott Reimbursement Team

  • Reimbursement Hotline: (855) 569-6430
  • Contact the Field Reimbursement Team by email

Access reimbursement resources for Coding and Coverage, Prior Authorization Management and Medicare.

Reimbursement information

What is a National Coverage Determination (NCD)?

A National Coverage Determination (NCD) is a Medicare policy that covers a specific medical item or service nationally. CMS now covers implantable pulmonary artery pressure sensor(s) for heart failure management when all NCD and Coverage with Evidence Development (CED) criteria are met.

The CardioMEMS HF System will now have expanded coverage through this NCD.

What is Coverage with Evidence Development (CED)?

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.

What is a National Clinical Trial (NCT) number?

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. 

What will an NCD mean in real-world practice?

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.

Reimbursement Contact Information

reimbursement hotline
Reimbursement
Hotline
Email for Patient Therapy Access
Field Reimbursement Team

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