Transcatheter Tricuspid Valve Repair or Replacement (T-TEER or TTVR)
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This policy governs coverage determinations for transcatheter tricuspid valve edge-to-edge repair and transcatheter tricuspid valve replacement for Commercial Products of Blue Cross Blue Shield - Rhode Island.
No material clinical or coverage changes in this revision.
Coverage Determinations
Commercial Products Coverage Stance
Coverage determination for Commercial Products:
For Medicare Advantage Plans, refer to the Related Policies section.
For Commercial Products, T-TEER (transcatheter tricuspid valve edge-to-edge repair) and TTVR (transcatheter tricuspid valve replacement) are not medically necessary. The policy states that the available evidence is insufficient to determine the effects of these technologies on health outcomes, and coverage for these procedures is therefore excluded for Commercial Products.
The following CPT codes are designated not medically necessary for Commercial Products: 0569T, 0570T, and 0646T.
Combined coverage position: T-TEER and TTVR are considered not medically necessary for Commercial Products due to insufficient evidence to demonstrate clinical benefit. Procedures billed with CPT codes 0569T, 0570T, and 0646T are listed as not medically necessary in support of this coverage determination.
Procedure and Billing Codes
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis |
| 0570T | Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (List separately in addition to code for primary procedure) |
| 0646T | Transcatheter tricuspid valve implantation (TTVI)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed |
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis |
| 0570T | Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (List separately in addition to code for primary procedure) |
| 0646T | Transcatheter tricuspid valve implantation (TTVI)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed |
Provider Responsibilities and Billing Guidance
Prior authorization not applicable — verify contract benefits
Prior authorization is not required under this policy; however, benefits may vary between groups/contracts — verify applicable surgery benefits in the member's Evidence of Coverage or Subscriber Agreement before scheduling procedures.
Confirm coverage — listed T-TEER/TTVR codes are not medically necessary
Claims for the CPT codes listed for transcatheter tricuspid valve procedures are designated not medically necessary for Commercial Products; confirm member coverage and eligibility prior to performing or billing these procedures.
Document prior conservative management (diuretics/surgical context)
Many patients with tricuspid regurgitation are managed medically (e.g., diuretics) or considered for surgical therapy before invasive transcatheter procedures; document prior conservative management when relevant to case review.
- Historically treatment options included diuretics for symptom relief or surgical intervention; many patients are treated medically before consideration of invasive procedures.
Provider action — verify coverage and follow documentation guidance
No specific provider action is listed in the policy beyond coverage and documentation guidance; follow the policy's coverage stance and verify member-specific benefits before proceeding.
Regulatory post-approval data — TriClip and EVOQUE (informational)
FDA-approved devices (TriClip and EVOQUE) are subject to post-approval studies and registry enrollment that will generate required data; these regulatory requirements are informational and are not payer prior authorization mandates.
- TriClip: two Post-Approval Studies including a continued follow-up cohort and a 5,000-patient registry with specific subgroup tracking.
- EVOQUE: registry-based study enrolling at least 5,000 consecutively treated patients with at least five years of follow-up.
Verify member benefits and eligibility; billing risks for non-covered services
Verify member benefits and eligibility with the member's subscriber agreement or employer agreement prior to providing services; do not bill members for services determined to be not medically necessary unless the member provides written agreement in advance.
- For member-specific benefits call the provider call center.
- Services determined to be not medically necessary may not be billed to the member unless informed consent in writing is obtained.
Not medically necessary for Commercial Products — T-TEER and TTVR
For Commercial Products, transcatheter tricuspid valve edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) are considered not medically necessary and are excluded from coverage under this policy.
Clinical Background
Tricuspid regurgitation (TR) is most often functional, resulting from right ventricular remodeling and annular dilation associated with left heart disease, pulmonary hypertension, or atrial fibrillation. TR prevalence increases with age and is associated with higher mortality, more frequent heart failure hospitalizations, and reduced quality of life. Surgical repair for isolated TR carries substantial perioperative risk and is underutilized, which has driven development of transcatheter approaches such as T-TEER (edge‑to‑edge leaflet approximation devices) and TTVR (transcatheter prosthetic valve implantation).
Procedure Definitions
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