CommercialCoverageMedium impact
Ventricular Assist Device (VAD) and Total Artificial Heart (TAH) 7.01.114
Excellus BlueCross BlueShield·Cardiology, Cardiothoracic Surgery, Critical Care·Heart & Blood Vessels (Cardiovascular)
Effective date
Mar 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their medical policy for Ventricular Assist Device (VAD) and Total Artificial Heart (TAH) coverage, effective March 19, 2026. The policy establishes specific medical necessity criteria for VADs as bridge to transplant, bridge to recovery, and destination therapy, as well as coverage criteria for percutaneous VADs and Total Artificial Hearts.
Action Required
By March 19, 2026: Review and update prior authorization processes for VAD and TAH procedures to align with new medical necessity criteria. Ensure documentation requirements include all specified clinical criteria such as NYHA Class ratings, ejection fraction percentages, and contraindication assessments. Update billing team training on the distinction between bridge to transplant, destination therapy, and bridge to recovery indications.