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) Device
- Sentinel Cerebral Protection System
 

Click to learn more about Medicare’s most recent payment policy changes

 

Coding and Payment Guides

 
Updated March 2022
Sentinel Reimbursement Guide
This comprehensive guide provides an overview of the coding, coverage and payment landscape for the SENTINELTM Cerebral Protection System
WATCHMAN FLX LAAC Device Reimbursement Guide
This comprehensive guide provides an overview of the coding, coverage and payment landscape for the WATCHMAN FLX LAAC Device.
 
 

Benefit Verification and Pre-Authorization

 
WATCHMAN Payer List
A full list of all private and public plans that cover the WATCHMAN FLX LAAC Device.
Structural Heart
This document has the FDA approval/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 FLX LAAC Device Supporting Patient Access Thumbnail
The following information is provided to assist providers in addressing patient-specific insurance requirements for the WATCHMAN FLX LAAC Device procedure and associated services.
Structural Heart
Use this form to help with submitting individual professional service reimbursement claims for WATCHMAN FLX LAAC Device procedures.
Structural Heart
Use this form to help with submitting hospital service reimbursement claims for WATCHMAN FLX LAAC Device procedures.
WATCHMAN Sample Letter of Medical Necessity
Template to assist with prior authorization of WATCHMAN FLX LAAC Device procedures based on utilizing the criteria of the NCD.
 

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 FLX LAAC Device Physician 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 FLX LAAC Device.
 
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resources

Resources

Find additional information on reimbursement, including summaries of CMS's annual rule updates for IPPS and OPPS

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