Medicare AdvantageCoverageMedium impact
Transcatheter Valve Procedures - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
Sep 10, 2026
We identified it
Sep 11, 2026
Summary
This is a revised Medicare Advantage coverage policy for transcatheter valve procedures (TAVR, TEER, TTVR, and related interventions) effective September 10, 2026. The policy establishes coverage criteria, references applicable CMS National Coverage Determinations, and outlines covered device types across all four cardiac valves. Billing teams must ensure claims align with the specific FDA-approved devices and clinical indications detailed in this policy.
Action Required
By September 10, 2026: Billing team must review and implement this revised Humana Medicare Advantage policy for transcatheter valve procedures in billing systems and prior authorization protocols. Verify that all TAVR, TEER, TTVR, and related valve procedure claims reference the FDA-approved device systems listed in the policy (e.g., Edwards Sapien 3/3 Ultra/3 Ultra Resilia, Medtronic CoreValve Evolut systems, Abbott Navitor, MitraClip G4, PASCAL Precision System, Tendyne, Tri-Clip, EVOQUE). Update prior authorization workflows to require documentation that procedures meet the specified clinical indications (e.g., TEER for prohibitive surgical risk patients with moderate-severe to severe mitral regurgitation). Cross-reference all claims against the related CMS NCDs/LCDs cited in the policy (NCD 20.32 for TAVR, 20.33 for mitral TEER, 20.37 for TTVR, 20.38 for tricuspid TEER). Claims submitted without alignment to this policy and CMS requirements may be denied.