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R13800CP: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)
Effective date
Mar 19, 2025
Identified
Jun 16, 2026
Summary
Medicare covers transcatheter tricuspid valve replacement (TTVR) for symptomatic tricuspid regurgitation under Coverage with Evidence Development, according to the criteria in NCD 20.37, effective March 19, 2025. Institutional and professional claims must carry specific ICD-10-PCS, CPT, ICD-10-CM, condition code, value code and modifier data, including the 8-digit National Clinical Trial number. Claims that do not meet these criteria are returned to provider or denied using the messages listed in the notice.
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What to do
Action · 6 steps
01Already effective March 19, 2025 (implementation January 5, 2026): Bill institutional TTVR claims for ICD-10-PCS X2RJ3RA or 02RJ38Z on Type of Bill 11X, with ICD-10-CM Z00.6 reported as the other diagnosis, condition code 30, and value code D4 with the 8-digit National Clinical Trial number.
02Inpatient hospitals bill TTVR on 11X.
03The principal ICD-10-CM diagnosis must be one of I07.1, I07.2, I08.1, I08.2, I08.3, I36.1, I36.2 or Q22.8.
04For Medicare Advantage enrollees, hospitals also report condition code 04.
05Professional claims for CPT 0646T in a clinical research study must carry modifier Q0, Z00.6 as the other diagnosis, the 8-digit clinical trial number, and one of the principal diagnoses listed above.
06Claims without these elements are returned to provider or denied, and line items are returned as unprocessable when modifier Q0 or the clinical trial number is missing.
Codes mentioned
I07.1I07.2I08.1I08.2I08.3I36.1I36.2Q22.8Z00.6
Original notice
R13800CP: NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)
cms.gov · Always check the source before changing claims.
Related changes
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