The Centers for Medicare & Medicaid Services (CMS) issued its final decision on July 31 to reimburse SynCardia System’s CardioWest temporary Total Artificial Heart through the highest paying diagnostic related group codes, MS-DRG 001 and 002.
In addition, CMS also approved the CardioWest (Jarvik) Total Artificial Heart (TAH-t) for new technology add-on payments for FY 2009, effective Oct. 1.
On May 1, CMS reversed its 1986 non-coverage policy for artificial hearts and approved Medicare reimbursement for the CardioWest TAH-t and Abiomed’s AbioCor Total Replacement Heart when implanted as part of an FDA study that meets CMS specifications.
For more than two decades prior to the May 1 decision, Medicare denied reimbursement for the artificial heart, despite reimbursements from private payors such as Aetna and BlueCross BlueShield.
With the July 31 decision, CMS said that “the TAH-t fulfills a role that no other mechanical circulatory support device can for patients in irreversible biventricular failure.”
The thresholds for new technology add-on payments for MS-DRGs 001 and 002 are $345,031 and $178,142 respectively and are retroactive to May 1. CMS also finalized a new technology add-on payment for the TAH-t of up to $53,000, starting Oct. 1, according to the Tucson, Ariz.-based CardioWest.
Rodger Ford, CEO and president of SynCardia, said that in the past, hospitals risked taking substantial economic losses to bridge patients to transplants. “This decision helps ensure that our hospitals receive adequate reimbursement for the life-saving artificial heart technology they provide,” Ford noted.