CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Cardiac Hemodynamic Monitoring

Defines coverage positions for outpatient cardiac hemodynamic monitoring methods (implantable pulmonary artery pressure sensors, thoracic electrical bioimpedance, inert gas rebreathing, arterial pressure during Valsalva, and noninvasive LVEDP devices) for Blue Cross & Blue Shield of Rhode Island across Medicare Advantage and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyCardiac Hemodynamic Monitoring

Policy CodePolicy N/A

Change TypeNon-material administrative update

Effective Date10/01/2019

Next Review DateN/A

Key ActionRefer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for limitations and applicability of not medically necessary/not covered benefits.

SourceLink

POLICY UPDATE CHANGES

Policy last updated 06/21/2023 with published Provider Update August 2023

1CPT covered for Medicare Advantage (TEB)

2CPT not covered / not medically necessary (implantable PA sensor)

1Unlisted code for other methods

Coverage Summary

Medical-Necessity Criteria

Medicare Advantage Plans - Thoracic Electrical Bioimpedance

Covered when the following condition applies:

ALL of the following

Cardiac hemodynamic monitoring for the management of heart failure using thoracic electrical bioimpedance (TEB)

Commercial Products - Thoracic Electrical Bioimpedance

Not medically necessary when the following applies:

ALL of the following

Cardiac hemodynamic monitoring for the management of heart failure using thoracic electrical bioimpedance (TEB)
Considered not medically necessary due to insufficient evidence to determine effects on health outcomes

Medicare Advantage Plans - Implantable PA Pressure, Inert Gas Rebreathing, Arterial Valsalva

Not covered when ALL of the following apply:

ALL of the following

Cardiac hemodynamic monitoring for the management of heart failure using implantable direct pressure monitoring of the pulmonary artery
Cardiac hemodynamic monitoring using inert gas rebreathing
Cardiac hemodynamic monitoring using arterial pressure during the Valsalva maneuver
Not covered as evidence is insufficient to determine effects on health outcomes

Commercial Products - Implantable PA Pressure, Inert Gas Rebreathing, Arterial Valsalva

Not medically necessary when ALL of the following apply:

ALL of the following

Cardiac hemodynamic monitoring for the management of heart failure using implantable direct pressure monitoring of the pulmonary artery
Considered not medically necessary due to insufficient evidence
Cardiac hemodynamic monitoring using inert gas rebreathing
Considered not medically necessary due to insufficient evidence
Cardiac hemodynamic monitoring using arterial pressure during the Valsalva maneuver
Considered not medically necessary due to insufficient evidence

Coding

Covered for Medicare Advantage (TEB)CPTCovered

93701

Bioimpedance-derived physiologic cardiovascular analysis

Not covered / Not medically necessary (Implantable PA sensor implantation and monitoring)CPTNot Covered

33289	Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed
93264	Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional

Unlisted code for inert gas rebreathing or LVEDPCPT

93799

Unlisted cardiovascular service or procedure (to be used for inert gas rebreathing measurement or left ventricular end diastolic pressure)

Provider Actions

Documentation Required

Refer to Benefit Booklet for benefit limits

Benefits may vary between groups and contracts; providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for limitations and applicability of not medically necessary/not covered benefits.

Billing Rule

Use unlisted code for inert gas rebreathing or LVEDP

Report inert gas rebreathing measurement or left ventricular end diastolic pressure using CPT 93799 (unlisted cardiovascular service or procedure) when no specific code exists.

Affected code: CPT 93799
Report inert gas rebreathing measurement or left ventricular end diastolic pressure using CPT 93799 when no specific code exists.

Documentation Required

Medicare guidance adherence

For Medicare Advantage Plans, BCBSRI follows CMS national/local coverage determinations; providers should be aware Medicare Advantage coverage may differ from Commercial products.

Background & Evidence

Outpatient cardiac hemodynamic monitoring devices aim to detect physiologic changes that precede clinical symptoms to allow preventive intervention. Devices operate through various mechanisms: implantable pressure sensors (e.g., CardioMEMS Champion HF Monitoring System) that are implanted via right heart catheterization and transmit pulmonary artery pressure readings wirelessly; thoracic bioimpedance (impedance cardiography) devices that noninvasively estimate cardiac output from changes in thoracic electrical resistance; inert gas rebreathing systems (e.g., Innocor) that estimate cardiac blood flow from disappearance of a soluble gas; and noninvasive LVEDP estimation devices (e.g., VeriCor) using arterial pressure during maneuvers such as the Valsalva. The policy summarizes evidence and FDA clearances/approvals for devices including CardioMEMS, VeriCor, and Innocor and specifies differing coverage positions for Medicare Advantage and Commercial products.

Evidence Type	Detail
FDA approval - CardioMEMS	Premarket approval in 2014 for the CardioMEMS Champion Heart Failure Monitoring System (implantable pulmonary artery pressure sensor) used for ambulatory management of heart failure.
FDA clearance - VeriCor	510(k) clearance in 2004 for the VeriCor device to noninvasively estimate left ventricular end-diastolic pressure (LVEDP); clearance notes clinical validation in males only.
FDA clearance - Innocor	510(k) clearance in 2006 for the Innocor inert gas rebreathing device for computing blood flow.
FDA clearance - Thoracic bioimpedance devices	Multiple thoracic impedance measurement devices cleared via 510(k) as substantially equivalent to existing peripheral blood flow monitoring devices.
Clinical evidence - CardioMEMS trials and studies	Randomized trials (e.g., CHAMPION) and post-approval studies report reductions in heart failure hospitalizations and other outcomes; evidence summarized but overall policy concludes insufficient to determine effects on health outcomes for some settings/devices.
Overview / Device types	Outpatient cardiac hemodynamic monitoring devices include implantable pressure sensors, thoracic bioimpedance, inert gas rebreathing, and arterial pressure during Valsalva to detect physiologic changes preceding symptoms for preventive intervention.
Coding / Coverage notes	CPT 93701 (bioimpedance) covered for Medicare Advantage but not medically necessary for Commercial; CPT 33289 and 93264 (implantable PA sensor implantation and monitoring) are not covered/not medically necessary; use 93799 for inert gas rebreathing or LVEDP when no specific code exists.

Thoracic Electrical Bioimpedance (TEB): Measurement of electrical resistance of current flow through the thorax to estimate cardiac output via impedance cardiography.

LVEDP: Left ventricular end-diastolic pressure; can be approximated by pulmonary artery pressure measurement or estimated noninvasively.

OpenPayer

Cardiac Hemodynamic Monitoring

Coverage Summary

Medical-Necessity Criteria

Coding

Provider Actions

Background & Evidence

Revision History