CurrentHealthPartnersPolicy N/A

Transcatheter Tricuspid Valve Replacement (TTVR)

Governs coverage of transcatheter tricuspid valve replacement (TTVR) for treatment of symptomatic tricuspid regurgitation (TR) for HealthPartners enrollees when furnished per a FDA market-authorized indication within a CMS-approved Coverage with Evidence Development (CED) study; applies to Medicare and Minnesota Medical Assistance enrollees under HealthPartners contracts.

Policy Summary

PayerHealthPartners

PolicyTranscatheter Tricuspid Valve Replacement (TTVR)

Policy CodePolicy N/A

Change TypeNational CED-based NCD added

Effective DateMar 19, 2025

Next Review DateN/A

Key ActionObtain and document patient enrollment in a CMS-approved CED study and ensure the TTVR is furnished according to a FDA market-authorized indication; follow HealthPartners prior authorization procedures as applicable.

SourceLink

POLICY UPDATE CHANGES

CMS established a National Coverage Determination (NCD) to cover TTVR for symptomatic TR under Coverage with Evidence Development (CED) when furnished according to a FDA market-authorized indication within a CMS-approved CED study.

CED-requiredCoverage pathway for TTVR

Symptomatic TRIndication covered under NCD

Mar 19, 2025Effective date of NCD

Medicare & MN MedicaidPrograms affected

Coverage Criteria for TTVR (NCD / CED)

Coverage under CED

Covered when ALL of the following are met

CED and FDA-indication requirement: Patient is enrolled in a CMS-approved Coverage with Evidence Development (CED) study and the TTVR is furnished according to a FDA market-authorized indication.CED enrollment and FDA market-authorized indication required

Refer to the Medicare final decision memo for complete coverage criteria.

Use of transcatheter tricuspid valve replacement (TTVR) outside a CMS-approved Coverage with Evidence Development (CED) study and not consistent with a FDA market-authorized indication is not covered under this National Coverage Determination (NCD).

Coding & Enrollment Requirements

Referenced codesmixed

H2462	Code referenced in document (historical/administrative reference)
H2422	Code referenced in document (historical/administrative reference)
H4882	Code referenced in document (historical/administrative reference)

Policy Summary

PayerHealthPartners

PolicyTranscatheter Tricuspid Valve Replacement (TTVR)

Policy CodePolicy N/A

Change TypeNational CED-based NCD added

Effective DateMar 19, 2025

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Requirements and Denial Risks

Prior Authorization

Prior Authorization and CED Enrollment Required

Prior authorization is required as applicable per HealthPartners procedures. Coverage is limited to patients enrolled in a CMS-approved Coverage with Evidence Development (CED) study and when the procedure is furnished in accordance with a FDA market-authorized indication.

Affected service: Transcatheter Tricuspid Valve Replacement (TTVR)
Enrollment requirement: Patient must be enrolled in a CMS-approved CED study
FDA indication: Procedure must be furnished according to a FDA market-authorized indication

Documentation Required

Provider Action — Document CED Enrollment and FDA Indication

Providers must ensure and clearly document that the patient is enrolled in a CMS-approved CED study prior to performing TTVR and that the procedure is furnished consistent with the FDA market-authorized indication.

Document CED study name/identifier on the medical record and claim
Document that the TTVR was performed per the FDA market-authorized indication

Denial Risk

Denial Risk for Non‑CED or Non‑FDA‑Indicated Use

Claims for TTVR furnished outside a CMS-approved CED study or not consistent with a FDA market-authorized indication are subject to denial.

Denial risk applies when patient is not enrolled in a CMS-approved CED study
Denial risk applies when procedure is not consistent with the FDA market-authorized indication

Note

Provider Billing and Documentation Reminder

Providers should treat the CED enrollment and FDA indication documentation as mandatory billing support; absence of this documentation may result in claim processing delays or denials.

Include CED enrollment evidence with the claim when required by HealthPartners procedures
Follow HealthPartners prior authorization process when applicable

Key Definitions

CED — Coverage with Evidence Development definition

DefinitionCoverage with Evidence Development (CED): a CMS coverage pathway that provides coverage for a technology contingent on data collection in CMS‑approved studies.

Application in this NCDCMS established CED for TTVR — coverage is provided when TTVR is furnished according to a FDA market‑authorized indication within a CMS‑approved CED study.

Relation to other policiesCED coverage does not preclude coverage under other CMS pathways (e.g., Clinical Trial Policy or IDE studies).

NCD — National Coverage Determination definition

DefinitionNational Coverage Determination (NCD): a CMS decision that establishes coverage rules at the national level.

This NCD's scopeThe NCD covers transcatheter tricuspid valve replacement (TTVR) for symptomatic tricuspid regurgitation (TR) under CED when furnished per a FDA market‑authorized indication within a CMS‑approved study.

Change from prior practiceReplaces prior local Medicare Administrative Contractor (MAC) discretion for TTVR; establishes national CED‑based coverage criteria.

OpenPayer

Transcatheter Tricuspid Valve Replacement (TTVR)

Coverage Criteria for TTVR (NCD / CED)

Coding & Enrollment Requirements

Provider Requirements and Denial Risks

Clinical Background

Key Definitions