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National Coverage Determination (NCD) for PARTIAL VENTRICULECTOMY (20.26)

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Benefit Category
Physicians' Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

Partial ventriculectomy, also known as ventricular reduction, ventricular remodeling, or heart volume reduction surgery, was developed by a Brazilian surgeon and has been performed only on a limited basis in the United States. This procedure is performed on patients with enlarged hearts due to end-stage congestive heart failure. Partial ventriculectomy involves reducing the size of an enlarged heart by excising a portion of the left ventricular wall followed by repair of the defect. It is asserted that this procedure makes the failing heart pump better by improving the efficiency of the remaining left ventricle.


Indications and Limitations of Coverage

Since the mortality rate is high and there are no published scientific articles or clinical studies regarding partial ventriculectomy, this procedure cannot be considered reasonable and necessary within the meaning of §1862(a)(1) of the Act. Therefore, partial ventriculectomy is not covered by Medicare.


Transmittal Number

93

Revision History

03/1997 - Provided noncoverage policy. Effective date 04/15/1997. (TN 93)


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