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Trans-Mitral Valve Repair Gains Medicare Coverage-With-Evidence Proposal

This article was originally published in The Gray Sheet

Executive Summary

A new draft national Medicare coverage policy offers to pay for transcatheter mitral valve repair procedures with devices like Abbott’s MitraClip only if they are conducted by a qualified heart team and are part of a national registry.

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CMS finalized a national coverage determination for transcatheter mitral valve repair, conditioned on a registry and on minimum facility and experience requirements for hospitals. The policy follows close behind a new-technology add-on payment granted to Abbott’s MitraClip device.

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CMS proposes to grant new hospital inpatient payment categories for transcatheter valve replacements, a potential boon to Edwards’ and Medtronic’s devices. But the Medicare agency continues to stand firm against upgrading payment levels for Abbott’s MitraClip percutaneous mitral valve repair procedure.

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