Reimbursement / Structural Heart

Structural Heart

Boston Scientific annually updates and provides procedural coding and reimbursement information for inpatient, outpatient, office, and ASC settings. Click on our guides to easily look up CPT codes, ICD-10 codes, physician RVUs, and Medicare national average reimbursement rates for:

- WATCHMAN Left Atrial Appendage Closure (LAAC)
- Lotus Edge Aortic Valve System
- Sentinel Cerebral Protection System

Medicare has released their proposed hospital inpatient rules for 2021

Learn about what may change

Coding and Payment Guides

Last update: May 2020

WATCHMAN Procedure Coding and Reimbursement Guide

This comprehensive guide provides an overview of the coding, coverage and payment landscape for the WATCHMAN system.

Update in progress. Please email watchman.reimbursement@bsci.com with questions.

TAVR Procedure Coding and Payment Guide

This comprehensive guide provides an overview of the coding, coverage and payment landscape for the LOTUS Edge^TM Aortic Valve System and SENTINEL^TM Cerebral Protection System.

Please email IC.Reimbursement@bsci.com with questions.

WATCHMAN Reimbursement (full insert)

This is a combination of all HEMA documents relevent to reimbursement/charging/documentation/peer appeal/etc.

Update in progress. Please email watchman.reimbursement@bsci.com with questions.

Benefit Verification and Pre-Authorization

WATCHMAN Importance of Documentation

This guide provides assistance on LAAC candidate documentation to ensure the appropriate acuity level for patients is assigned.

WATCHMAN Payer List

A full list of all private and public plans that cover the WATCHMAN implant

WATCHMAN Approval/ Coverage Status and Clinical Evidence Summary

This document has the FDA/coverage status and clinical evidence summary. This comprehensive information is intended to be used to support the prior authorization, appeal, and peer to peer processes.

Supporting Patient Access to the WATCHMAN LAAC Therapy

Use this guide for help addressing your patients' insurance requirements for WATCHMAN LAAC procedures and associated services.

WATCHMAN Claim Form 1500

Use this form to help with submitting individual professional (italicize individual professional) service reimbursement claims for WATCHMAN LAAC procedures.

WATCHMAN CMS Inpatient UB-04 Claim Form

Use this form to help with submitting hospital hospital service reimbursement claims for WATCHMAN^TM LAAC procedures.

WATCHMAN Sample Letter of Medical Necessity

Template to assist with prior authorization of the WATCHMAN therapy based on utilizing the criteria of the NCD.

WATCHMAN Provider Intake Form

This document is intended to assist with prior-authorization of the WATCHMAN therapy.

WATCHMAN Prior- Authorization and Appeal Request Form

This form is intended to assist with the prior authorization and appeal process.

Claims Denial Assistance

WATCHMAN Sample Appeals Template

Template to assist providers with appealing denials by utilizing the criteria of the NCD for percutaneous LAAC therapy in referencing patient’s eligibility.

WATCHMAN Approval/ Coverage Status and Clinical Evidence Summary

This document has the FDA/coverage status and clinical evidence summary. This comprehensive information is intended to be used to support the prior authorization, appeal, and peer to peer processes.

WATCHMAN Prior Authorization and Appeal Request Form

This form is intended to assist with the prior authorization and appeal process.

WATCHMAN Peer to Peer Appeal Guide

Quick reference guide intended to support peer-to-peer appeal conversations between the implanting physician and health plan Medical Directors following denial of coverage for the WATCHMAN (LAAC) Device.