CMS Pub. 100-04, ch. 32, § 290.3

Hospital Claims

(Rev. 10179, Issued: 06-10-20, Effective: 06-21-19, Implementation: 06-12-20)

Inpatient hospitals shall bill for TAVR on an 11X TOB effective for discharges on or after

May 1, 2012. Refer to Section 69 of this chapter for further guidance on billing under CED.

Inpatient hospital discharges for TAVR shall be covered when billed with:

• ICD-9 V70.7 through September 30, 2015, ICD-10 Z00.6 for dates of service on or after

October 1, 2015. and Condition Code 30.

• An 8-digit clinicaltrials.gov identifier number listed on the CMS website (effective July 1,

2013)

Inpatient hospital discharges for TAVR shall be rejected when billed without:

• ICD-9 V70.7 through September 30, 2015, ICD-10 Z00.6 for dates of service on or after

October 1, 2015, and Condition Code 30.

• An 8-digit clinicaltrials.gov identifier number listed on the CMS website (effective July 1,

2013)

Claims billed by hospitals not participating in the trial/registry shall be rejected with the

following messages:

CARC 50: These are non-covered services because this is not deemed a “medical necessity”

by the payer.

RARC N386: This decision was based on a National Coverage Determination (NCD). An

NCD provides a coverage determination as to whether a particular item or service is covered.

A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp. If you do not

have web access, you may contact the contractor to request a copy of the NCD.

Group Code:Contractual Obligation (CO)

MSN 16.77: This service/item was not covered because it was not provided as part of a

qualifying trial/study. Spanish version: Este servicio/artículo no fue cubierto porque no estaba

incluido como parte de un ensayo clínico/estudio calificado.