US · guidance
CMS Pub. 100-04, ch. 32, § 414.3
Claims Processing Instructions for TTVR Institutional Claims
Inpatient hospitals shall bill for TTVR on an 11X Type of Bill (TOB).
Inpatient hospital claims for TTVR shall be covered when billed with:
• ICD-10-PCS code X2RJ3RA or 02RJ38Z,
• ICD-10 Z00.6 (as other diagnosis code),
• Condition Code 30,
• Value Code D4 to indicate the 8-digit clinical trial identifier number, and
• One of the ICD-10 diagnosis codes listed in section 414.1 as principal diagnosis code
NOTE: When submitting claims for TTVR provided to Medicare Advantage enrollees, hospitals also report
condition code 04. Medicare Advantage Organizations are responsible for payment of the service,
consistent with Pub. 100-16, chapter 4, section 10.7.3.
History
(Rev. 13800; Issued:05-28-26; Effective: 03-19-25; Implementation: 01-05-26)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1e2931f08d36c285ca708b61e6c47527c80e5853a694912f96e1e98e696aa001
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