After great effort by the ACC and the Heart Failure Society of America, the Centers for Medicare and Medicaid Services (CMS) informed both societies on Nov. 22 that a new specialty designation for “Advanced Heart Failure and Transplant Cardiology” has been approved.

The new designation will allow CMS to distinguish Heart Failure (HF) and transplant cardiologists from clinical cardiologists when billing for Medicare services. Previously, no mechanism existed for CMS to accurately identify this category of physician for quality and payment programs. Some local Medicare carriers have denied claims in the past, citing duplicate billing, when a cardiologist and an HF specialist from the same practice have billed for patient evaluation services.

Once CMS takes necessary steps to create the new code, which could take up to a year or more, it will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient.

“This is important to me personally because it validates our specialty,” said Biykem Bozkurt, MD, PhD, FACC, chair of ACC’s Heart Failure and Transplant Section Leadership Council in an interview with Cardiology magazine. “We, the advanced heart failure cardiologists, value and take pride in the care we provide and believe it is a unique practice with specialized training and expertise, as also recognized by other cardiologists referring their patients who seek our care.”

“The approval of the new heart failure specialty designation code is the culmination of years of collaborative work between the Heart Failure Society of America and the ACC,” said Mary Norine Walsh, MD, FACC, president elect of the ACC. “Ultimately, this designation will allow advanced heart failure/transplant cardiologists to be appropriately reimbursed for their care of a complex patient cohort.”

“Approval of the unique specialty code for the ‘Advanced Heart Failure and Transplant’ by CMS is a critical achievement for our specialty,” adds Bozkurt. “This is the long awaited acknowledgment of the existence of advanced heart failure and transplant cardiologists, and it provides the opportunity for validation of the valuable efforts our providers in the treatment of advanced heart failure and transplant patients. The collaborative efforts spearheaded by the ACC and HFSA have resulted in this important milestone. While the implementation process by CMS may take up to a year, we will continue to work collaboratively on development of the process for successful implementation.”

Stay tuned for more information following the creation and implementation of the new code.

Keywords: Achievement, Centers for Medicare and Medicaid Services, U.S., Heart Failure, Leadership, Medicaid, Medicare, Medicine, Cardiology Magazine, ACC Publications