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CMS Transmittals



National Coverage Determination
Procedure Code: 33983
Ventricular Assist Devices
CMS Policy Number: 20.9.1
Back to NCD List



To review all requirements of this policy, please see: CMS NCD listing by Chapter

Covered ICD-10 Codes.

ICD-10Descriptor
I09.81 Rheumatic heart failure
I11.0 Hypertensive heart disease with heart failure
I13.0 Hyp hrt & chr kdny dis w hrt fail and stg 1-4/unsp chr kdny
I13.2 Hyp hrt & chr kdny dis w hrt fail and w stg 5 chr kdny/ESRD
I20.0 Unstable angina
I21.01 STEMI involving left main coronary artery
I21.02 STEMI involving left anterior descending coronary artery
I21.09 STEMI involving oth coronary artery of anterior wall
I21.11 STEMI involving right coronary artery
I21.19 STEMI involving oth coronary artery of inferior wall
I21.21 STEMI involving left circumflex coronary artery
I21.29 STEMI involving oth sites
I21.3 ST elevation (STEMI) myocardial infarction of unsp site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent STEMI of anterior wall
I22.1 Subsequent STEMI of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent STEMI of sites
I22.9 Subsequent STEMI of unsp site
I24.0 Acute coronary thrombosis not resulting in myocardial infrc
I24.1 Dressler's syndrome
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Athscl heart disease of native coronary artery w/o ang pctrs
I25.110 Athscl heart disease of native cor art w unstable ang pctrs
I25.111 Athscl heart disease of native cor art w ang pctrs w spasm
I25.118 Athscl heart disease of native cor art w oth ang pctrs
I25.119 Athscl heart disease of native cor art w unsp ang pctrs
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.700 Atherosclerosis of CABG, unsp, w unstable angina pectoris
I25.701 Athscl CABG, unsp, w angina pectoris w documented spasm
I25.708 Atherosclerosis of CABG, unsp, w oth angina pectoris
I25.709 Atherosclerosis of CABG, unsp, w unsp angina pectoris
I25.710 Athscl autologous vein CABG w unstable angina pectoris
I25.711 Athscl autologous vein CABG w ang pctrs w documented spasm
I25.718 Athscl autologous vein CABG w oth angina pectoris
I25.719 Athscl autologous vein CABG w unsp angina pectoris
I25.720 Athscl autologous artery CABG w unstable angina pectoris
I25.721 Athscl autologous artery CABG w ang pctrs w documented spasm
I25.728 Athscl autologous artery CABG w oth angina pectoris
I25.729 Athscl autologous artery CABG w unsp angina pectoris
I25.730 Athscl nonautologous biological CABG w unstable ang pctrs
I25.731 Athscl nonaut biological CABG w ang pctrs w documented spasm
I25.738 Athscl nonautologous biological CABG w oth angina pectoris
I25.739 Athscl nonautologous biological CABG w unsp angina pectoris
I25.750 Athscl native cor art of txplt heart w unstable angina
I25.751 Athscl native cor art of txplt heart w ang pctrs w spasm
I25.758 Athscl native cor art of transplanted heart w oth ang pctrs
I25.759 Athscl native cor art of transplanted heart w unsp ang pctrs
I25.760 Athscl bypass of cor art of txplt heart w unstable angina
I25.761 Athscl bypass of cor art of txplt heart w ang pctrs w spasm
I25.768 Athscl bypass of cor art of txplt heart w oth ang pctrs
I25.769 Athscl bypass of cor art of txplt heart w unsp ang pctrs
I25.790 Atherosclerosis of CABG w unstable angina pectoris
I25.791 Atherosclerosis of CABG w angina pectoris w documented spasm
I25.798 Atherosclerosis of CABG w oth angina pectoris
I25.799 Atherosclerosis of CABG w unsp angina pectoris
I25.810 Atherosclerosis of CABG w/o angina pectoris
I25.811 Athscl native cor art of transplanted heart w/o ang pctrs
I25.812 Athscl bypass of cor art of transplanted heart w/o ang pctrs
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
I34.2 Nonrheumatic mitral (valve) stenosis
I34.8 Other nonrheumatic mitral valve disorders
I34.9 Nonrheumatic mitral valve disorder, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I36.0 Nonrheumatic tricuspid (valve) stenosis
I36.1 Nonrheumatic tricuspid (valve) insufficiency
I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
I36.8 Other nonrheumatic tricuspid valve disorders
I36.9 Nonrheumatic tricuspid valve disorder, unspecified
I37.0 Nonrheumatic pulmonary valve stenosis
I37.1 Nonrheumatic pulmonary valve insufficiency
I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
I37.8 Other nonrheumatic pulmonary valve disorders
I37.9 Nonrheumatic pulmonary valve disorder, unspecified
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disord in dis classd elswhr
I42.0 Dilated cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
I47.2 Ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 Paroxysmal atrial fibrillation
I48.1 Persistent atrial fibrillation
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 Atrial premature depolarization
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia, unspecified
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unsp combined systolic and diastolic (congestive) hrt fail
I50.41 Acute combined systolic and diastolic (congestive) hrt fail
I50.42 Chronic combined systolic and diastolic hrt fail
I50.43 Acute on chronic combined systolic and diastolic hrt fail
I50.84 End stage heart failure
I50.9 Heart failure, unspecified
I51.4 Myocarditis, unspecified
I51.9 Heart disease, unspecified
I52 Other heart disorders in diseases classified elsewhere
I97.0 Postcardiotomy syndrome
I97.110 Postproc cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Oth postproc cardiac functn disturb fol cardiac surgery
I97.191 Oth postproc cardiac functn disturb following oth surgery
I97.710 Intraoperative cardiac arrest during cardiac surgery
I97.711 Intraoperative cardiac arrest during other surgery
I97.790 Oth intraop cardiac functn disturb during cardiac surgery
I97.791 Oth intraop cardiac functional disturb during oth surgery
I97.88 Oth intraoperative complications of the circ sys, NEC
I97.89 Oth postproc comp and disorders of the circ sys, NEC
M32.11 Endocarditis in systemic lupus erythematosus
R00.1 Bradycardia, unspecified
R57.0 Cardiogenic shock
T82.221A Breakdown (mechanical) of biological heart valve graft, init
T82.222A Displacement of biological heart valve graft, init encntr
T82.223A Leakage of biological heart valve graft, initial encounter
T82.228A Mech compl of biological heart valve graft, init encntr
T82.512A Breakdown (mechanical) of artificial heart, init encntr
T82.514A Breakdown (mechanical) of infusion catheter, init encntr
T82.518A Breakdown of cardiac and vascular devices and implants, init
T82.522A Displacement of artificial heart, initial encounter
T82.528A Displacmnt of cardiac and vascular devices and implnt, init
T82.529A Displacmnt of unsp cardiac and vasc devices and implnt, init
T82.532A Leakage of artificial heart, initial encounter
T82.538A Leakage of cardiac and vascular devices and implants, init
T82.592A Mech compl of artificial heart, initial encounter
T82.598A Mech compl of cardiac and vascular devices and implnt, init
T86.20 Unspecified complication of heart transplant
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.30 Unspecified complication of heart-lung transplant
T86.31 Heart-lung transplant rejection
T86.32 Heart-lung transplant failure
T86.33 Heart-lung transplant infection
T86.39 Other complications of heart-lung transplant
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status

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