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

Learn about what may change

Coding and Payment Guides

Updated March 2022

Cardiovascular Procedure Coding and Payment Guide

SENTINEL^TM Cerebral Protection System Payment Guide

This comprehensive guide provides an overview of the coding, coverage and payment landscape for the SENTINEL^TMCerebral 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 FLX LAAC Device Payer List

A full list of all private and public plans that cover the WATCHMAN FLX LAAC Device.

WATCHMAN Approval/Coverage Status and Clinical Evidence Summary

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

Supporting Patient Access to the WATCHMAN FLX LAAC Device Therapy

The following information is provided to assist providers in addressing patient-specific insurance requirements for the WATCHMAN FLX LAAC Device procedure and associated services.

WATCHMAN FLX™ LAAC Device Claim Form 1500

Use this form to help with submitting individual professional service reimbursement claims for WATCHMAN FLX LAAC Device procedures.

WATCHMAN FLX™ LAAC Device CMS Inpatient UB-04 Claim Form

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

WATCHMAN Sample Letter of Medical Necessity

WATCHMAN FLX LAAC Device 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 FLX LAAC Device 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

WATCHMAN FLX LAAC Device 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.