Appendix E - National Coverage Determinations Manual / Artificial Hearts and Related Devices 20.9

Why This Topic Matters

Coverage policy for advanced cardiac support devices affects whether services are reimbursable and what documentation, facility capabilities, and patient-selection criteria must be in place. Understanding the policy helps organizations align clinical workflows, transplant coordination, and billing practices with Medicare requirements.

Article Sections

1. A. General

   Provides a general overview of the devices addressed in the policy and the clinical contexts in which they are discussed.

2. B. Nationally Covered Indications

   Outlines the main covered categories under the Medicare policy and the conditions associated with each category. It also includes patient-selection and facility-related requirements for the covered uses described in the article.

3. Patient Selection

   Describes the broad eligibility framework applied to one covered use category, including the types of clinical and functional factors referenced in the policy.

4. Facility Criteria

   Summarizes the facility capability and credentialing requirements referenced for participating hospitals and programs.

5. The Web site

   Points to the public CMS resource used to identify approved facilities and notes that the list is updated over time.

6. C. Nationally Non-Covered Indications

   Identifies the broad category of uses that Medicare does not cover under this policy, along with limited exceptions mentioned in the article.

7. Artificial Heart

   Addresses the non-covered use category involving replacement of the human heart and the policy’s treatment of other uses not otherwise listed.