Medicare AdvantageCoverageMedium impact
MA11.027g, Transcatheter Cardiac Valve Procedures
Independence Blue Cross·Cardiology, Cardiothoracic Surgery, Critical Care +1 more·Medical Policy
Effective date
Jul 2, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA policy MA11.027g to MA11.027h, adding coverage for transcatheter tricuspid valve repair procedures (CPT codes 0569T and 0570T) under a Coverage with Evidence Development (CED) program, effective July 2, 2025. The policy was reissued on April 1, 2026 to communicate the company's continuing position on transcatheter cardiac valve procedures.
Action Required
By July 2, 2025: Billing team must update billing system to recognize CPT codes 0569T and 0570T as medically necessary for transcatheter tricuspid valve repair procedures when billed with appropriate diagnosis codes and CED criteria are met. Verify that the system requires documentation of heart team evaluation (cardiac surgeon and interventional cardiologist involvement) prior to claim submission. Update encounter forms and clinical documentation templates to capture required heart team assessment information. Train billing staff and providers on CED program requirements and ensure claims for these codes are submitted with the Q0 modifier when applicable per CMS CED guidelines. Failure to properly document and code these procedures may result in claim denials or payment delays.