All PlansCoverageMedium impact
Transcatheter Tricuspid Valve Repair or Replacement
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Cardiothoracic Surgery·Medical Policy
We identified it
Jun 20, 2026
Summary
New policy establishes coverage for transcatheter tricuspid valve repair (TriClip G4) and replacement (EVOQUE) procedures for patients with severe tricuspid regurgitation who are at intermediate or high surgical risk and have failed optimal medical therapy. Both procedures require heart team assessment and are considered medically necessary when FDA-approved devices are used for appropriate candidates.
Action Required
Immediately: Review patient cases for transcatheter tricuspid valve procedures to ensure proper documentation of severe tricuspid regurgitation, heart team assessment, surgical risk stratification (STS score or heart team judgment), and failure of optimal medical therapy. Verify procedures use FDA-approved devices (TriClip G4 or EVOQUE systems). Update prior authorization workflows to include heart team composition requirements and TR severity grading per policy guidelines.