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February 19, 2015

Coverage for Closure or Occlusion of the Left Atrial Appendage (LAA)

There have been a number of studies related to cardiac devices for the occlusion of the left atrial appendage (e.g., Amplatzer cardiac plug, Amulet, AtriClip device, Lariat Snare device, Watchman device; this is not an all-inclusive list). With the exception of the Watchman device, the majority of studies did not support a conclusion of improved health outcomes for our Medicare beneficiaries.  The use of these devices is considered experimental and investigational for prevention of stroke and all other indications because their effectiveness has not been established.

Effective for dates of service on or after April 8, 2015, all LAA devices, with the exception of the Watchman device, will be considered experimental and investigational at this time.

Watchman Device
Submit claims for insertion of the Watchman device associated with approved clinical trials with CPT code 0281T and HCPCS modifier Q0 (zero) modifier.  Refer to the CGS Local Coverage Determination (LCD) and corresponding articles for Category III Codes:

  • Local Coverage Determination (LCD) L31832:
    • KentuckyExternal Website
    • OhioExternal Website
    • Local Coverage Articles A50740 and A50906 provide supplemental instructions regarding coverage and claim submission.  Links to both articles are available at the end of the LCD (see the section Associated Documents).

All Other LAA Devices
Submit claims for all other LAA devices (e.g., Amplatzer cardiac plug, Amulet, AtriClip device, Lariat Snare device; this is not an all-inclusive list) using CPT code 33999.  A concise description of the service is required, although the service will not be covered.

Reference

  • More information regarding claim submission associated with clinical trials is available in CMS MLN Matters article MM8921External PDF, “Medicare Coverage of Items and Services in Category A and B Investigational Device Exemption (IDE) Studies”

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