CMS finalizes the TAVR coverage rewrite, heart team survives

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CMS finalizes the TAVR coverage rewrite, heart team survives

Plus: ACC asks CMS to delay mandatory heart-failure model, reverse procedure cuts. The day's rules, money, and enforcement, sourced and tiered below.

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CMS closed a nine-month fight this week: its rewritten Medicare coverage rule for TAVR, the catheter-based heart valve replacement, drops a registry requirement for the sickest patients but keeps cardiac surgeons on every case.

The new National Coverage Determination drops the evidence-development registry for symptomatic patients, adds asymptomatic coverage under research only, and sets a 20-procedures-a-year operator floor instead of a hospital volume minimum.

Record

The American College of Cardiology, the specialty's largest physician group, wants CMS to delay its mandatory heart-failure payment model and reverse double-digit pay cuts to heart valve and imaging procedures.

ACC's CY2027 fee schedule comments ask CMS to make the Ambulatory Specialty Model's first year no-risk and delay its Jan 1, 2027 start, plus restore RUC-recommended pay for left atrial appendage closure, tricuspid valve repair, and IVUS.

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