Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), Ch. 1 § 20.26

Partial Ventriculectomy

Last amended: 2003Year: 2003Length: 160 wordsOfficial source
20.26 - Partial Ventriculectomy (Rev. 1, 10-03-03) CIM 35-95 (Also Known as Ventricular Reduction, Ventricular Remodeling, or Heart Volume Reduction Surgery) Not Covered Partial ventriculectomy, also known as ventricular reduction, ventricular remodeling, or heart volume reduction surgery, was developed by a Brazilian surgeon and has been performed only on a limited basis in the United States. This procedure is performed on patients with enlarged hearts due to end-stage congestive heart failure. Partial ventriculectomy involves reducing the size of an enlarged heart by excising a portion of the left ventricular wall followed by repair of the defect. It is asserted that this procedure makes the failing heart pump better by improving the efficiency of the remaining left ventricle. Since the mortality rate is high and there are no published scientific articles or clinical studies regarding partial ventriculectomy, this procedure cannot be considered reasonable and necessary within the meaning of §1862(a)(1) of the Act. Therefore, partial ventriculectomy is not covered by Medicare.
Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), Ch. 1 § 20.26: Partial Ventriculectomy | Justis AI