Local Coverage Article Billing and Coding

Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices

A52967

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Contractor Information

Article Information

General Information

Article ID
A52967
Article Title
Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

N/A

Article Guidance

Article Text

Effective for dates of service on/after February 3, 2014.

Noridian will cover the percutaneous insertion of an endovascular cardiac assist device itself under limited conditions. Until the literature clearly demonstrates the efficacy of the treatment approach, coverage may be made only in the following two life-threatening situations and only when external counterpulsation (intraaortic balloon pump, IABP) is not expected to be sufficient; Cardiogenic shock or Severe decompensated heart failure with threatening multi-organ failure.

This service will only be covered when the FDA approval guidelines are strictly followed.

Due to the expansion of NCD 20.9.1-Ventricular Assist Devices (VADs) to include left ventricular assist devices for long-term (destination therapy) mechanical circulatory support per Change Request 12290, Noridian will cover artificial hearts for destination therapy when all the criteria outlined NCD 20.9.1 are met and the FDA approval guidelines are strictly followed effective December 1, 2020.

Coding Information

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

Part B Providers – Use the following CPT codes to report percutaneous endovascular ventricular assist devices.

 

Group 1 Codes
CodeDescription
33990 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, ARTERIAL ACCESS ONLY
33991 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, BOTH ARTERIAL AND VENOUS ACCESS, WITH TRANSSEPTAL PUNCTURE
33995 INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; RIGHT HEART, VENOUS ACCESS ONLY
33997 REMOVAL OF PERCUTANEOUS RIGHT HEART VENTRICULAR ASSIST DEVICE, VENOUS CANNULA, AT SEPARATE AND DISTINCT SESSION FROM INSERTION

Group 2

(3 Codes)
Group 2 Paragraph

Part B Providers - Use the following CPT® codes to report artificial heart procedures. 

Group 2 Codes
CodeDescription
33927 IMPLANTATION OF A TOTAL REPLACEMENT HEART SYSTEM (ARTIFICIAL HEART) WITH RECIPIENT CARDIECTOMY
33928 REMOVAL AND REPLACEMENT OF TOTAL REPLACEMENT HEART SYSTEM (ARTIFICIAL HEART)
33929 REMOVAL OF A TOTAL REPLACEMENT HEART SYSTEM (ARTIFICIAL HEART) FOR HEART TRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(30 Codes)
Group 1 Paragraph

Cardiogenic shock ICD-10-CM code R57.0, or severe decompensated heart failure with threatening multi-organ failure and using an FDA approved device, represented by one of the following ICD-10-CM codes.

Group 1 Codes
CodeDescription
I50.1* Left ventricular failure, unspecified
I50.20* Unspecified systolic (congestive) heart failure
I50.21* Acute systolic (congestive) heart failure
I50.22* Chronic systolic (congestive) heart failure
I50.23* Acute on chronic systolic (congestive) heart failure
I50.30* Unspecified diastolic (congestive) heart failure
I50.31* Acute diastolic (congestive) heart failure
I50.32* Chronic diastolic (congestive) heart failure
I50.33* Acute on chronic diastolic (congestive) heart failure
I50.40* Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41* Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42* Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43* Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.84* End stage heart failure
I50.9* Heart failure, unspecified
I51.4* Myocarditis, unspecified
I51.9* Heart disease, unspecified
I5A Non-ischemic myocardial injury (non-traumatic)
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.710 Intraoperative cardiac arrest during cardiac surgery
I97.711 Intraoperative cardiac arrest during other surgery
I97.790 Other intraoperative cardiac functional disturbances during cardiac surgery
I97.791 Other intraoperative cardiac functional disturbances during other surgery
I97.88 Other intraoperative complications of the circulatory system, not elsewhere classified
I97.89 Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
R57.0 Cardiogenic shock
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

All the asterisked diagnosis codes listed in Group 1 will only be payable when billed with ICD-10-PCS Code 02WA4QZ - Revision of Implantable Heart Assist System in Heart, Percutaneous Endoscopic Approach in the hospital setting effective DOS 04/01/2022.

Group 2

(242 Codes)
Group 2 Paragraph

The following diagnosis codes are covered for artificial heart devices.

Group 2 Codes
CodeDescription
I09.81 Rheumatic heart failure
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I20.0 Unstable angina
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.112 Atherosclerosic heart disease of native coronary artery with refractory angina pectoris
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
I34.2 Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I34.9 Nonrheumatic mitral valve disorder, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I36.0 Nonrheumatic tricuspid (valve) stenosis
I36.1 Nonrheumatic tricuspid (valve) insufficiency
I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
I36.8 Other nonrheumatic tricuspid valve disorders
I36.9 Nonrheumatic tricuspid valve disorder, unspecified
I37.0 Nonrheumatic pulmonary valve stenosis
I37.1 Nonrheumatic pulmonary valve insufficiency
I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
I37.8 Other nonrheumatic pulmonary valve disorders
I37.9 Nonrheumatic pulmonary valve disorder, unspecified
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I42.0 Dilated cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 Atrial premature depolarization
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia, unspecified
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.84 End stage heart failure
I50.9 Heart failure, unspecified
I51.4 Myocarditis, unspecified
I51.9 Heart disease, unspecified
I52 Other heart disorders in diseases classified elsewhere
I5A Non-ischemic myocardial injury (non-traumatic)
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
I97.710 Intraoperative cardiac arrest during cardiac surgery
I97.711 Intraoperative cardiac arrest during other surgery
I97.790 Other intraoperative cardiac functional disturbances during cardiac surgery
I97.791 Other intraoperative cardiac functional disturbances during other surgery
I97.88 Other intraoperative complications of the circulatory system, not elsewhere classified
I97.89 Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
M32.11 Endocarditis in systemic lupus erythematosus
Q20.0 Common arterial trunk
Q20.1 Double outlet right ventricle
Q20.2 Double outlet left ventricle
Q20.3 Discordant ventriculoarterial connection
Q20.4 Double inlet ventricle
Q20.5 Discordant atrioventricular connection
Q20.6 Isomerism of atrial appendages
Q20.8 Other congenital malformations of cardiac chambers and connections
Q20.9 Congenital malformation of cardiac chambers and connections, unspecified
Q21.0 Ventricular septal defect
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
Q21.13 Coronary sinus atrial septal defect
Q21.14 Superior sinus venosus atrial septal defect
Q21.15 Inferior sinus venosus atrial septal defect
Q21.16 Sinus venosus atrial septal defect, unspecified
Q21.19 Other specified atrial septal defect
Q21.21 Partial atrioventricular septal defect
Q21.22 Transitional atrioventricular septal defect
Q21.23 Complete atrioventricular septal defect
Q21.3 Tetralogy of Fallot
Q21.4 Aortopulmonary septal defect
Q21.8 Other congenital malformations of cardiac septa
Q21.9 Congenital malformation of cardiac septum, unspecified
Q22.0 Pulmonary valve atresia
Q22.1 Congenital pulmonary valve stenosis
Q22.2 Congenital pulmonary valve insufficiency
Q22.3 Other congenital malformations of pulmonary valve
Q22.4 Congenital tricuspid stenosis
Q22.5 Ebstein's anomaly
Q22.6 Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q22.9 Congenital malformation of tricuspid valve, unspecified
Q23.0 Congenital stenosis of aortic valve
Q23.1 Congenital insufficiency of aortic valve
Q23.2 Congenital mitral stenosis
Q23.3 Congenital mitral insufficiency
Q23.4 Hypoplastic left heart syndrome
Q23.8 Other congenital malformations of aortic and mitral valves
Q23.9 Congenital malformation of aortic and mitral valves, unspecified
Q24.0 Dextrocardia
Q24.1 Levocardia
Q24.2 Cor triatriatum
Q24.3 Pulmonary infundibular stenosis
Q24.4 Congenital subaortic stenosis
Q24.5 Malformation of coronary vessels
Q24.6 Congenital heart block
Q24.8 Other specified congenital malformations of heart
Q24.9 Congenital malformation of heart, unspecified
R00.1 Bradycardia, unspecified
R57.0 Cardiogenic shock
T82.221A Breakdown (mechanical) of biological heart valve graft, initial encounter
T82.222A Displacement of biological heart valve graft, initial encounter
T82.223A Leakage of biological heart valve graft, initial encounter
T82.228A Other mechanical complication of biological heart valve graft, initial encounter
T82.512A Breakdown (mechanical) of artificial heart, initial encounter
T82.514A Breakdown (mechanical) of infusion catheter, initial encounter
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.522A Displacement of artificial heart, initial encounter
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.529A Displacement of unspecified cardiac and vascular devices and implants, initial encounter
T82.532A Leakage of artificial heart, initial encounter
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.592A Other mechanical complication of artificial heart, initial encounter
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T86.20 Unspecified complication of heart transplant
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.30 Unspecified complication of heart-lung transplant
T86.31 Heart-lung transplant rejection
T86.32 Heart-lung transplant failure
T86.33 Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

Part A providers use the following ICD-10-PCS Codes to report endovascular cardiac assist devices.

Group 1 Codes
CodeDescription
02WA4QZ Revision of Implantable Heart Assist System in Heart, Percutaneous Endoscopic Approach
5A02216 Assistance with Cardiac Output using Other Pump, Continuous
5A0221D Assistance with Cardiac Output using Impeller Pump, Continuous

Group 2

(3 Codes)
Group 2 Paragraph

Part A providers use the following ICD-10-PCS Codes to report artificial heart devices.

NOTE: Total artificial heart is reported with a “cluster” of 2 codes for open replacement with synthetic substitute of the right and left ventricles- 02RK0JZ + 02RL0JZ.

Group 2 Codes
CodeDescription
02RK0JZ Replacement of Right Ventricle with Synthetic Substitute, Open Approach
02RL0JZ Replacement of Left Ventricle with Synthetic Substitute, Open Approach
02WA0JZ Revision of Synthetic Substitute in Heart, Open Approach

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
011x Hospital Inpatient (Including Medicare Part A)

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R12

Asterisked ICD-10 codes I50.21, I50.23, I50.31, I50.33, I50.41, I50.43, added the asterisked codes I50.1, I50.20, I50.22, I50.30, I50.32, I50.40, I50.42, I50.84, I50.9, I51.4, and I51.9 and added the statement "All the asterisked diagnosis codes listed in Group 1 will only be payable when billed with ICD-10-PCS Code 02WA4QZ - Revision of Implantable Heart Assist System in Heart, Percutaneous Endoscopic Approach in the hospital setting effective DOS 04/01/2022" to the Group1 Medical Necessity ICD-10-CM Codes Asterisk Explanation section.

Deleted ICD-10 codes I50.811 and I50.813 because Noridian does not cover ventricular assist devices for right heart failure at this time.

10/01/2022 R11

Updated the verbiage to Group 1 paragraph to include: and using an FDA approved device

Added ICD-10 codes to Group 1:

I50.21, I50.23, I50.41, I50.43, I97.110, I97.111, I97.130, I97.131, I50.31, I50.33, I50.811, I50.813

10/01/2022 R10

Per the Annual ICD-10-CM Update:

  • Deleted I34.8, I47.2, W21.1 & Q21.2. These codes were replaced with I34.81, I 34.89. I47.21 & I47.29. 11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16, Q21.19, Q21.21, Q21.22 & Q21.23 effective 10/01/2022.
  • Added new ICD-10-CM I25.112, I25.702, I25.712. I25.722. I25.732, I25.752. I25.762 & I25.792, also effective 10/1/2022 to Group 2 in the ICD-10-CM Codes That Support Medical Necessity.  
04/01/2022 R9

Added 02WA4QZ to the Group 1 ICD-10-PCS codes effective 04/01/2022 per CR 12480.

10/01/2021 R8

Added I5A to the Group 2 list of payable ICD-10 codes effective 10/01/2021 missed in previous update.

10/01/2021 R7

Added I5A and R57.0 to the Gr1 list of payable ICD-10 codes. R57.0 was just listed in the Gr1 Paragraph. I5A is effective 10/01/2021.

Correction to the previous Revision History includes changing the Title of the article form Billing and Coding: Percutaneous Endovascular Cardiac Assist Procedures and Devices to Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices to include coverage for artificial hearts.

08/20/2021 R6

Added coverage and coding information for Artificial Hearts when all the criteria in the FDA label and NCD 20.9.1 is met.

01/01/2021 R5

Added ICD-10-PSC Code 5A02216 for Part A providers/facilities and CPT® codes 33995 and 33997 for Part B providers. Also, the code descriptions for 33990 and 33991 changed. 33990-from INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; ARTERIAL ACCESS ONLY to INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, ARTERIAL ACCESS ONLY and 33991 from INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; BOTH ARTERIAL AND VENOUS ACCESS, WITH TRANSSEPTAL PUNCTURE to INSERTION OF VENTRICULAR ASSIST DEVICE, PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LEFT HEART, BOTH ARTERIAL AND VENOUS ACCESS, WITH TRANSSEPTAL PUNCTURE in the CPT/HCPCS Codes section

The addition of 33995 and 33997 and the code description changes are per the 2021 CPT/HCPCS Codes Annual update effective 01/01/2021.

10/01/2015 R4

Article converted to Billing and Coding, no change in coverage made.

10/01/2015 R3 R3- Changed ICD-10-PCS code from 02HL3DZ back to 5A0221D. Article number A52944 for JEA will be retired on 5/15/16. This article will be the same as Article number A52967 for JFB and combines both contract numbers for both JFA & JFB.
10/01/2015 R2 R2-Revised to add Cardiogenic shock or Severe decompensated heart failure with threatening multi-organ failure after the word sufficient and replaced the words "adhered to" to followed in the article text. Also changed the ICD-10-PCS from 5A0221D to 02HL3DZ.
10/01/2015 R1 R1 Article revised to change ICD-10-CM procedure code from 02HL3DZ to ICD-10-PCS code 5A0221D

Associated Documents

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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
09/30/2022 10/01/2022 - N/A Currently in Effect You are here
09/16/2022 10/01/2022 - N/A Superseded View
09/02/2022 10/01/2022 - N/A Superseded View
04/19/2022 04/01/2022 - 09/30/2022 Superseded View
11/16/2021 10/01/2021 - 03/31/2022 Superseded View
11/11/2021 10/01/2021 - N/A Superseded View
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Keywords

  • VAD, Cardiac, Assist, Device, Percutaneous, Endovascular, 33990 & 33991, 5A0221D