CurrentCentenePolicy CP.MP.160

Implantable Wireless Pulmonary Artery Pressure Monitoring

Defines Centene-affiliated non-Medicare health plan policy on long-term safety and effectiveness of implantable wireless pulmonary artery pressure monitoring for heart failure and related coding implications; refers Medicare-specific criteria to MC.CP.MP.160.

Policy Summary

PayerCentene

PolicyImplantable Wireless Pulmonary Artery Pressure Monitoring

Policy CodePolicy CP.MP.160

Change TypeAdministrative clarifications / annual review

Effective Date

Next Review Date

Key ActionWhen assessing Medicare members/enrollees, providers must apply Medicare criteria and refer to MC.CP.MP.160 rather than this non-Medicare policy.

SourceLink

POLICY UPDATE CHANGES

Added note to policy to refer to MC.CP.MP.160 for Medicare criteria and specified 'non-Medicare' plans in Policy/Criteria I.

Updated background and references with no impact on clinical criteria during annual reviews through 04/24.

0Covered Indications (non-Medicare)

3Key referenced procedure/supply codes

Coverage Summary

Scope summary: This policy defines the position for Centene-affiliated non‑Medicare health plans on implantable wireless pulmonary artery pressure monitoring (e.g., CardioMEMS). For these non‑Medicare plans the long-term safety and effectiveness of implantable wireless pulmonary artery pressure monitoring has not been proven for any indication.

Coverage stance headline: Implantable wireless pulmonary artery pressure monitoring (CardioMEMS) is not covered / not proven for any indication under Centene-affiliated non‑Medicare plans. For Medicare members/enrollees, separate Medicare-specific criteria apply (refer to MC.CP.MP.160). Policy last reviewed: 04/24/2024.

Policy/Criteria

Coverage determination for non-Medicare Centene-affiliated health plans

The long-term safety and effectiveness of implantable wireless pulmonary artery pressure monitoring has not been proven for any indication, including the management of heart failure.

For Medicare members/enrollees, separate criteria apply; refer to MC.CP.MP.160 Implantable Wireless Pulmonary Artery Pressure Monitoring.

Coding

Procedure CPT (referenced)CPT

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

HCPCS / SupplyHCPCS

C2624

Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components

Billing Rule

Code references for services and devices

Use CPT 33289 for implantation procedure, CPT 93264 for up to 30 days of remote monitoring, and HCPCS C2624 for the implantable sensor/delivery catheter when submitting claims; inclusion of codes does not guarantee coverage.

33289
93264
C2624

Provider Actions & Billing Guidance

Documentation Required

Refer Medicare members to Medicare-specific policy

When assessing Medicare members/enrollees, providers must apply Medicare criteria and refer to MC.CP.MP.160 rather than this non-Medicare policy.

Operational guidance: When submitting claims, use the referenced procedure and supply codes (e.g., CPT 33289, CPT 93264, HCPCS C2624) as applicable; inclusion of codes in this policy is for informational purposes only and does not guarantee coverage for non‑Medicare plans. For Medicare members/enrollees, apply Medicare-specific criteria and refer to MC.CP.MP.160 for Medicare coverage rules.

Background & Evidence Summary

Background: The CardioMEMS HF System is an FDA-approved implantable wireless pulmonary artery pressure sensor system that provides daily measurements of pulmonary artery pressures to guide heart failure management. The FDA approval is for use in NYHA Class III heart failure patients who have been hospitalized for heart failure in the previous year.

Policy rationale: Randomized trial data (CHAMPION) showed reductions in heart failure–related hospitalizations, but there are important limitations and unanswered questions. Available evidence is insufficient regarding long-term health benefits (including survival), safety, and quality-of-life outcomes to support routine outpatient use in non‑Medicare populations; therefore long-term safety and effectiveness remain not proven for non‑Medicare use.

CHAMPION trial 6-month result31% vs 44% (device vs control)

CHAMPION 18-month result46% vs 68% (device-guided vs control)

Device-related complication rate1%

Definitions

CardioMEMS HF System: FDA-approved implantable wireless pulmonary artery pressure sensor system for NYHA Class III heart failure patients with a hospitalization for heart failure in the prior year.

Non‑Medicare health plans: Centene-affiliated plans other than Medicare; this policy applies to those plans and declares the technology not proven for any indication.

Type	Name	Number	Effective Date
NCD	Hemodynamic-GUIDEd Management of Heart Failure (IDE Category B)	NCT03387813	2018-02

Revision History

04/23clarified

Annual review; added note to policy to refer to MC.CP.MP.160 for Medicare criteria and added 'non-Medicare' to health plans in Policy/Criteria I; background updated with no clinical impact.

08/23clarified

Revision noting addition of note to refer to MC.CP.MP.160 for Medicare criteria and inclusion of 'non-Medicare' in Policy/Criteria I (administrative clarification only).

04/24revisedLatest

Annual review; references reviewed and updated; background updated with no impact on clinical criteria.