Medicare AdvantageCoverageMedium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross·Cardiology, Cardiothoracic Surgery, Radiology·Medical Policy
Effective date
Jul 2, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued MA11.027g (now superseded by MA11.027h) to communicate updated coverage criteria for transcatheter cardiac valve procedures, specifically adding CPT codes 0569T and 0570T for transcatheter edge-to-edge repair of tricuspid valve regurgitation under Medicare's Coverage with Evidence Development (CED) program effective 07/02/2025.
Action Required
By 07/02/2025: Billing team must update billing software to recognize CPT codes 0569T and 0570T as medically necessary for tricatheter edge-to-edge repair procedures on tricuspid valve regurgitation when submitted under the CED program with appropriate Q0 modifiers. Verify that encounter forms and prior authorization templates are updated to reflect the new coverage criteria aligned with CMS NCD requirements. Providers must ensure documentation includes heart team evaluation, FDA-approved device confirmation, and in-person TAVR operator assessment prior to procedure date. Update internal policies to reflect that MA11.027h supersedes MA11.027g; discard old policy version. Failure to implement CED submission requirements will result in claim denials for tricuspid valve procedures.