Pulmonary embolism (PE) typically occurs when a thrombus (clot) that forms in the body, such as in the deep veins of the legs, breaks loose, travels through the venous system, and gets lodged in one or more pulmonary arteries in the lungs. Patients diagnosed with acute PE are risk-stratified to guide appropriate treatment. Depending on the risk of death, treatment escalates from standard anticoagulation (to prevent future clots from forming), to systemic fibrinolysis (intravenous drugs that break up existing clots), and then to catheter-directed therapies as an alternative to surgical embolectomy. These treatments are often used in combination in certain patients. Transvenous (catheter) pulmonary embolectomy is a procedure to remove the clot by passing a catheter (typically through the fermoral vein) and mechanically extracting the clot.
Transvenous (Catheter) Pulmonary Embolectomy is currently non-covered.
CMS internally generated this NCA reconsideration based upon stakeholder feedback. We received three requests for CMS to remove the NCD using the expedited process established in the August 7, 2013 Federal Register (78 FR 48164). We also received nine comments to the 2021 Medicare Physician Fee Schedule Proposed Rule recommending that CMS consider removing this NCD in the future.