CurrentBlue Cross Blue Shield - MassachusettsPolicy N/A

Transcatheter_Tricuspid_Valve_Repair_and_Replacement_Policy

Defines medical necessity criteria, contraindications, authorization requirements, coding guidance, and evidence summary for transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) for Commercial and Medicare members of Blue Cross Blue Shield Massachusetts.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyTranscatheter_Tricuspid_Valve_Repair_and_Replacement_Policy

Policy CodePolicy N/A

Change TypeNew policy; material updates

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionPrecertification/prior authorization is required for inpatient procedures and providers must document heart team assessment, surgical risk, prior maximally tolerated guideline-directed medical therapy, contraindications, and evidence-development participation as applicable.

SourceLink

POLICY UPDATE CHANGES

New medical policy describing medically necessary and investigational indications for T-TEER and TTVR was added.

T-TEER and TTVR considered investigational in all other situations.

2Device classes with coverage statements (T-TEER, TTVR)

3Key CPT codes referenced

24 monthsRequired evidence-development reporting duration