CommercialCoverageLow impact
Transcatheter Pulmonary Valve Implantation
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Cardiothoracic Surgery, Pediatrics·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their policy for Transcatheter Pulmonary Valve Implantation (TPVI), defining when this cardiac procedure is considered medically necessary versus investigational. The policy covers FDA-approved valve implantation for specific congenital heart disease conditions with RVOT obstruction or regurgitation.
Action Required
Immediately: Billing team should review claims for transcatheter pulmonary valve implantation (CPT 33477) to ensure they meet the specific medical necessity criteria outlined in the policy. Verify patients have congenital heart disease with RVOT obstruction/regurgitation and document appropriate clinical indicators (moderate pulmonic regurgitation or mean RVOT gradient ≥35 mm Hg). Claims not meeting these criteria will be considered investigational and denied.