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
 

Coding and Payment Guides

 
Last update: January 2020
Structural Heart

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.

Structural Heart
This comprehensive guide provides an overview of the coding, coverage and payment landscape for the SentinelTM Cerebral Protection System.
Structural Heart

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

 
Structural Heart
This guide provides assistance on LAAC candidate documentation to ensure the appropriate acuity level for patients is assigned.
Structural Heart
A full list of all private and public plans that cover the WATCHMAN implant
Structural Heart
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.
Structural Heart
Use this guide for help addressing your patients' insurance requirements for WATCHMAN LAAC procedures and associated services.
Structural Heart
Use this form to help with submitting individual professional (italicize individual professional) service reimbursement claims for WATCHMAN LAAC procedures.
Structural Heart
Use this form to help with submitting hospital hospital service reimbursement claims for WATCHMANTM LAAC procedures.
Structural Heart
Template to assist with prior authorization of the WATCHMAN therapy based on utilizing the criteria of the NCD.
 
Structural Heart
This document is intended to assist with prior-authorization of the WATCHMAN therapy.
Structural Heart
This form is intended to assist with the prior authorization and appeal process.

Claims Denial Assistance

 
Structural Heart
Template to assist providers with appealing denials by utilizing the criteria of the NCD for percutaneous LAAC therapy in referencing patient’s eligibility.
 
Structural Heart
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.
Structural Heart
This form is intended to assist with the prior authorization and appeal process.
Structural Heart
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.
 
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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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