Surgical Ventricular Restoration
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This policy addresses coverage and medical policy determinations for surgical ventricular restoration (SVR) — procedures to restore left ventricular shape/volume in patients with ischemic dilated cardiomyopathy — for Blue Cross Blue Shield of North Carolina members and providers.
No material clinical or coverage changes in this revision.
Coverage Determination
Coverage determination
Policy decision
BCBSNC does not provide coverage for investigational services or procedures.
Surgical ventricular restoration (SVR) is not covered when performed for the treatment of ischemic dilated cardiomyopathy because it is considered investigational. BCBSNC does not provide coverage for investigational services or procedures.
SVR remains classified as investigational and therefore not eligible for coverage for members with ischemic dilated cardiomyopathy. Claims for this service will be denied on that basis.
Applicable Codes
| 33548 | 33548 |
Provider Requirements and Billing Guidance
Applicable code listed — prior authorization may be required
Code 33548 is listed as an applicable procedure code for this policy; inclusion here does not guarantee reimbursement and prior authorization may be required per payer administrative policies and medical necessity review.
- Applicable CPT: 33548
- Prior authorization: may be required per BCBSNC administrative policies and medical necessity review — see payer site for details.
Check payer reimbursement rules before submitting claims
Follow BCBSNC administrative guidance for billing and reimbursement; inclusion of a code in the policy’s coding section does not guarantee payment and providers should consult Blue Cross Blue Shield of North Carolina administrative policies for reimbursement rules.
- Inclusion of a code in this section does not guarantee that it will be reimbursed.
- See Administrative Policies on the BCBSNC website (Category Search on the Medical Policy search page) for reimbursement guidelines.
Medical records may be requested for medical necessity review
BCBSNC may request medical records to determine medical necessity; when records are requested, include all specific information needed for determination because letters of support or explanation alone are not sufficient.
- BCBSNC may request medical records for determination of medical necessity.
- Letters of support/explanation are often useful but are not sufficient unless all specific information needed to make a medical necessity determination is included.
Denial risk — SVR considered investigational
Claims for surgical ventricular restoration (SVR) for treatment of ischemic dilated cardiomyopathy will be denied as investigational — submission risks denial.
- Policy stance: “Surgical ventricular restoration is considered investigational for the treatment of ischemic dilated cardiomyopathy.”
- BCBSNC does not provide coverage for investigational services or procedures.
Clinical Background
Surgical ventricular restoration (SVR) is a surgical technique intended to remodel the left ventricle toward a more normal shape and volume in patients with akinetic or dyskinetic segments after myocardial infarction. Procedures described as SVR include endoventricular circular plasty (the Dor procedure), may use purse‑string sutures or patch reconstruction for larger defects, and are often performed in conjunction with coronary artery bypass grafting and, when indicated, mitral valve procedures or endocardectomy. SVR is distinct from partial left ventriculectomy and ventriculectomy for aneurysm removal.
Key Definitions
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