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MA11.119, Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management
Effective date
Jan 13, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued MA11.119 with no substantive changes on 01/13/2025. This policy covers implantable pulmonary artery pressure sensors (PAPS) for heart failure management exclusively through Medicare's Coverage with Evidence Development (CED) program when strict clinical criteria are met. Billing teams must verify patient enrollment in an approved CED study and confirm all seven clinical conditions are documented before claims submission.
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What to do
Action · 7 steps
01By 01/13/2025: Billing team must implement the following in billing software and prior authorization workflows.
02Require verification that patient is enrolled in a CMS-approved CED study before authorizing CPT 33289 (implantation) or submitting related claims.
03Confirm documentation of all seven clinical criteria: chronic HF ≥3 months with NYHA Class II/III, prior HF hospitalization or urgent visit within 12 months (or elevated natriuretic peptides), maximally tolerated GDMT for ≥3 months, prior evaluation/implantation of ICD/CRT device ≥3 months before, no major cardiovascular event in prior 3 months, reliable data connectivity access, and no implantation during acute HF admission.
04Verify referring and implanting physicians meet specialty requirements (cardiologists with advanced HF experience for referral/management; advanced training in pulmonary arterial catheterization for implantation).
05Bill implantation (CPT 33289), remote monitoring (CPT 93264), device (HCPCS C2624), and replacement equipment (HCPCS G0555) only when all conditions are documented.
06Update encounter forms and prior auth templates to include CED study verification field.
07Consequences: Claims will be denied if CED enrollment cannot be verified or required clinical criteria are not documented.
Codes mentioned
3328993264C2624G0555Z00.6
Original notice
MA11.119, Implantable Pulmonary Artery Pressure Sensors for Heart Failure Management
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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