NCD 20.9.1: Transcatheter Aortic Valve Replacement (TAVR)
Medicare covers TAVR for symptomatic aortic stenosis with FDA-approved device, multidisciplinary heart team evaluation, and Coverage with Evidence Development requirements.
What's covered
- TAVR for severe symptomatic aortic stenosis
- Use of FDA-approved devices
- All risk groups (low, intermediate, high, prohibitive surgical risk)
Coverage criteria
- Symptomatic severe AS (mean gradient ≥40 mmHg, peak velocity ≥4 m/s, OR AVA ≤1.0 cm²)
- Heart team evaluation (cardiac surgeon + interventional cardiologist)
- Patient-specific shared decision-making
- Facility meets volume and credentialing requirements
- Registry participation (CED)
Exclusions
- Asymptomatic aortic stenosis
- Non-FDA-approved devices outside trial
Common denial patterns
- Heart team eval not documented
- Facility doesn't meet volume requirements
- Symptoms or hemodynamics not documented
Appeal citation
NCD 20.9.1 (TAVR), 2019. Document heart team eval, AS severity (echo), facility credentials, registry enrollment.
Frequently asked questions
What does Medicare NCD 20.9.1 cover?
Medicare covers TAVR for symptomatic aortic stenosis with FDA-approved device, multidisciplinary heart team evaluation, and Coverage with Evidence Development requirements.
What are the coverage criteria?
Symptomatic severe AS (mean gradient ≥40 mmHg, peak velocity ≥4 m/s, OR AVA ≤1.0 cm²); Heart team evaluation (cardiac surgeon + interventional cardiologist); Patient-specific shared decision-making; Facility meets volume and credentialing requirements; Registry participation (CED).
What is excluded?
Asymptomatic aortic stenosis; Non-FDA-approved devices outside trial.
How do I cite this NCD in an appeal?
NCD 20.9.1 (TAVR), 2019. Document heart team eval, AS severity (echo), facility credentials, registry enrollment.
Other Cardiology NCDs
Sources
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