CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Outpatient Cardiac Hemodynamic Monitoring for Heart Failure (implantable PA sensors, bioimpedance, inert gas rebreathing, Valsalva)

Policy governs coverage and medical necessity determinations for outpatient cardiac hemodynamic monitoring technologies (implantable pulmonary artery pressure sensors, thoracic electrical bioimpedance, inert gas rebreathing, and arterial pressure during Valsalva) for management of heart failure for BlueCHiP for Medicare and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyOutpatient cardiac hemodynamic monitoring for heart failure

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2019

Next Review DateN/A

Key ActionDo not submit CPT codes 33289 or 93264 for BlueCHiP for Medicare or Commercial — these services are not covered/are considered not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

33289, 93264New CPT codes (implantable PA sensor)

93701Bioimpedance code

CardioMEMS (2014)FDA PMA device

InsufficientEvidence conclusion

NMN

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Coverage Criteria

Coverage by product and modality

Coverage stance varies by product type and monitoring modality:

BlueCHiP for Medicare - Thoracic Electrical Bioimpedance: Cardiac hemodynamic monitoring for the management of heart failure using thoracic electrical bioimpedance is covered.

BCBSRI must follow CMS guidelines; BlueCHiP for Medicare policies may differ from commercial products.

Commercial Products - Thoracic Electrical Bioimpedance: Cardiac hemodynamic monitoring for the management of heart failure using thoracic electrical bioimpedance (TEB) is considered not medically necessary due to insufficient evidence.

BlueCHiP for Medicare - Implantable PA pressure, inert gas rebreathing, Valsalva: Cardiac hemodynamic monitoring for the management of heart failure using implantable direct pulmonary artery pressure monitoring, inert gas rebreathing, and arterial pressure during the Valsalva maneuver is not covered due to insufficient evidence.

Commercial Products - Implantable PA pressure, inert gas rebreathing, Valsalva: Cardiac hemodynamic monitoring using implantable direct pulmonary artery pressure monitoring, inert gas rebreathing, and arterial pressure during the Valsalva maneuver is considered not medically necessary due to insufficient evidence.

Implantable PA sensor evidence statement: Although the CardioMEMS implantable pulmonary artery pressure sensor received FDA premarket approval, the evidence is considered insufficient in this policy to determine effects on health outcomes for outpatient heart failure monitoring.

CardioMEMS (PMA 2014) has FDA clearance but policy concludes evidence is insufficient.

Overall coverage conclusion for implantable PA pressure sensors

Summary stance

Main conclusion: For individuals with heart failure in outpatient settings who receive hemodynamic monitoring with an implantable pulmonary artery pressure sensor device, the evidence is insufficient to determine the effects of the technology on health outcomes.

Concludes insufficient evidence for clinical benefit.

Coverage conclusion for other hemodynamic monitoring techniques

Other outpatient hemodynamic monitoring methods

Other methods: For individuals who receive hemodynamic monitoring by thoracic impedance, inert gas rebreathing, or arterial pressure during the Valsalva maneuver, the evidence is insufficient to determine effects on health outcomes.

Insufficient evidence statement for these modalities.

Implantable pulmonary artery (PA) pressure sensor devices are implanted in the distal pulmonary artery and transmit pulmonary artery pressure measurements to a secure database for outpatient hemodynamic monitoring. CPT code 33289 describes the transcatheter implantation of a wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography when performed. CPT code 93264 describes 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.

CPT codes 33289 and 93264 for implantation and remote monitoring of a wireless pulmonary artery pressure sensor are not covered for BlueCHiP for Medicare and are not medically necessary for Commercial products.

Thoracic electrical bioimpedance (TEB) for outpatient cardiac hemodynamic monitoring is treated differently by product: it is covered for BlueCHiP for Medicare but is considered not medically necessary for Commercial products. Other modalities—implantable direct pulmonary artery pressure monitoring, inert gas rebreathing, and arterial pressure during the Valsalva maneuver—are not covered for BlueCHiP for Medicare and considered not medically necessary for Commercial products due to insufficient evidence of benefit.

Explicitly, CPT code 33289 (implantation of a wireless PA pressure sensor) and CPT code 93264 (remote monitoring of a wireless PA pressure sensor) are not covered for BlueCHiP for Medicare and are not medically necessary for Commercial products. CPT code 93701 (bioimpedance-derived physiologic cardiovascular analysis) is covered for BlueCHiP for Medicare but is considered not medically necessary for Commercial products.

Coding

Covered (BlueCHiP for Medicare) / Not medically necessary (Commercial) - BioimpedanceCPT

93701

Bioimpedance-derived physiologic cardiovascular analysis

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

33289	Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring (New Code Effective 1/1/2019)
93264	Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads, interpretation, trend analysis, and reports (New Code Effective 1/1/2019)

Covered for BlueCHiP for Medicare / Not medically necessary for CommercialCPT

93701

Bioimpedance-derived physiologic cardiovascular analysis

New codes for implantation and remote monitoringCPTNot 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 (New Code Effective 1/1/2019)
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 (New Code Effective 1/1/2019)

Unlisted code for inert gas rebreathing or LVEDP measurementsCPT

93799

Unlisted cardiovascular service or procedure

Provider Actions & Billing guidance

Note

Prior Authorization

Prior authorization requirement — Not applicable

Denial Risk

Denial Triggers by Product & Modality

Denial triggers by product and modality: use of implantable pulmonary artery (PA) pressure sensors, inert gas rebreathing, and arterial pressure measurement during the Valsalva maneuver are not covered or are considered not medically necessary depending on product. Specifically, these modalities are not covered for BlueCHiP for Medicare and are considered not medically necessary for Commercial Products.

BlueCHiP for Medicare: implantable PA pressure monitoring, inert gas rebreathing, arterial pressure during Valsalva — NOT COVERED
Commercial Products: implantable PA pressure monitoring, inert gas rebreathing, arterial pressure during Valsalva — NOT MEDICALLY NECESSARY

Background

Outpatient cardiac hemodynamic monitoring devices are intended to detect physiologic changes before clinical decompensation, with the goal of reducing hospitalizations and improving management of heart failure. Techniques addressed in this policy include implantable pulmonary artery pressure sensors (which can provide continuous PA pressure data), thoracic bioimpedance (impedance cardiography), inert gas rebreathing to estimate cardiac output, and noninvasive LVEDP estimation methods such as arterial pressure during the Valsalva maneuver. The policy notes that standard invasive pulmonary artery catheter monitoring remains the criterion standard but is invasive and not suitable for routine outpatient management.

Definitions

Thoracic bioimpedance (impedance cardiography) definition

DefinitionMeasurement of electrical resistance through the thorax (bioimpedance or impedance cardiography) to estimate stroke volume and cardiac output from pulsatile changes; current flows along the blood‑filled aorta and beat‑to‑beat impedance changes correlate inversely with aortic blood volume and velocity.

Clinical useUsed to estimate cardiac output and stroke volume noninvasively for outpatient hemodynamic monitoring in heart failure.

Alternate nameImpedance cardiography

Policy coverage noteCovered for BlueCHiP for Medicare but considered not medically necessary for Commercial products (see coding/coverage sections).

Inert gas rebreathing definition

Definition

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyOutpatient cardiac hemodynamic monitoring for heart failure

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2019

Next Review DateN/A

Key ActionDo not submit CPT codes 33289 or 93264 for BlueCHiP for Medicare or Commercial — these services are not covered/are considered not medically necessary.

SourceLink

On This Page

Billing Rule

Noncoverage of New PA Sensor CPT Codes

New CPT codes for wireless pulmonary artery (PA) pressure sensor implantation and remote monitoring (effective 1/1/2019) are not covered for BlueCHiP for Medicare and are considered not medically necessary for Commercial Products. Providers should not use the unlisted code for these services effective 1/1/2019.

33289 — Transcatheter implantation of wireless PA pressure sensor (New Code Effective 1/1/2019) — Not covered (BlueCHiP for Medicare); Not medically necessary (Commercial)
93264 — Remote monitoring of a wireless PA pressure sensor up to 30 days (New Code Effective 1/1/2019) — Not covered (BlueCHiP for Medicare); Not medically necessary (Commercial)

Note

Benefit Booklet / Evidence of Coverage Reference

Refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for contract-specific limitations and for applicable not medically necessary/not covered benefits/coverage.

Billing Rule

Unlisted Code Guidance for Inert Gas Rebreathing / LVEDP

For reporting inert gas rebreathing measurements or left ventricular end diastolic pressure (LVEDP), there is no specific CPT code; report using the unlisted cardiovascular code as applicable.

Use 93799 — Unlisted cardiovascular service or procedure for inert gas rebreathing or LVEDP reporting

Technique in which a patient rebreathes from a bag containing oxygen mixed with fixed proportions of a blood‑soluble inert gas (e.g., nitrous oxide) and an insoluble gas (e.g., sulfur hexafluoride); uptake of the soluble gas is proportional to cardiac blood flow while the insoluble gas determines lung volume for calculation.

Measurement methodContinuous, simultaneous measurement of the gases and carbon dioxide at the mouthpiece during rebreathing to compute cardiac blood flow (cardiac output).

Typical gasesSoluble: nitrous oxide; Insoluble: sulfur hexafluoride.

Policy noteConsidered not medically necessary for Commercial products and not covered for BlueCHiP for Medicare per policy conclusions on hemodynamic monitoring modalities.

LVEDP estimation definition and approaches

DefinitionLeft ventricular end‑diastolic pressure (LVEDP) is an estimate of left ventricular filling pressure that is elevated in acute decompensated heart failure.

Invasive approachDirect catheter measurement during cardiac catheterization is the criterion standard but is invasive and not suitable for outpatient monitoring.

Noninvasive approachesImplantable pulmonary artery pressure sensors that approximate LVEDP via PA pressure measurements, and arterial pressure responses during the strain phase of the Valsalva maneuver which correlate with LVEDP.

Policy contextNoninvasive LVEDP estimation methods (Valsalva, implantable PA sensor approximations) have insufficient evidence to determine effects on health outcomes in outpatient heart failure monitoring per the policy.

Implantable pulmonary artery (PA) sensor device definition

DefinitionAn implantable pulmonary artery (PA) sensor device is an implanted sensor placed in the distal pulmonary artery (or right ventricular outflow tract) delivered via a transvenous right‑heart catheterization system that transmits PA pressure measurements wirelessly to external processors and a secure database.

Example deviceCardioMEMS Champion Heart Failure Monitoring System (FDA premarket approval in 2014; now St. Jude Medical/Abbott).

ImplantationSensor is implanted via right heart catheterization (typically via femoral vein access) and may require post‑procedure observation; transmits readings wirelessly for ambulatory management.

Policy coverage noteEvidence is insufficient to determine effects on health outcomes for outpatient heart failure monitoring with implantable PA pressure sensor devices; CPT codes for implantation and remote monitoring (33289, 93264) are not covered for BlueCHiP for Medicare and are considered not medically necessary for Commercial products.