The Centers for Medicare and Medicaid Services (CMS) has released the long-awaited draft national coverage decision (NCD) for transcatheter mitral valve repair (TMVR).

Notably, CMS has replaced the TMVR term with transcatheter edge-to-edge repair (TEER) in an effort to "more precisely define the treatment addressed" and avoid confusion with other therapies to repair or replace the mitral valve.

As expected, the proposed NCD includes a revision of covered indications to add secondary/functional mitral regurgitation (FMR). It also incorporates an emphasis on care by a comprehensive heart team and includes facility and operator infrastructure and volume requirements.

Of note, CMS does not propose a coverage with evidence development policy requiring participation in a registry, noting that the evidence for an FMR indication is strong enough to meet the threshold of reasonable and necessary coverage.

In adding FMR coverage, CMS declined to continue the NCD for degenerative mitral regurgitation (DMR), proposing instead to leave DMR coverage decisions to local contractors given the relatively low incidence of clip intervention needed in this case.

CMS began the process of reconsidering its TMVR NCD  last year as a direct result of advocacy efforts requesting reconsideration from the ACC and others, including the Society of Thoracic Surgeons, the Society for Cardiovascular Angiography, and the American Association for Thoracic Surgery.

The College is currently reviewing the proposed NCD in greater detail and working with these societies to provide comments by the July 30 comment deadline.

 

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging, Mitral Regurgitation

Keywords: ACC Publications, Cardiology Magazine, Mitral Valve Insufficiency, Mitral Valve, Thoracic Surgery, Incidence, Centers for Medicare and Medicaid Services, U.S., Centers for Medicare and Medicaid Services, U.S., Medicaid, Medicare, Cardiac Surgical Procedures, Confusion, Surgical Instruments, Registries, Surgeons, Angiography

< Back to Listings