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Medicare program; criteria for Medicare coverage of heart transplants--HCFA. Notice of HCFA ruling
Insights
Medicare now covers heart transplants for eligible patients at approved facilities. This decision follows the National Heart Transplant Study, establishing heart transplantation as medically necessary under specific criteria.
Area of Science:
- Medical policy and coverage decisions
- Cardiovascular surgery and transplantation
Background:
- Medicare previously excluded heart transplantations from coverage.
- HCFA Ruling HCFAR 80-1 specifically detailed this exclusion.
Purpose of the Study:
- To extend Medicare coverage to heart transplantations.
- To establish new coverage criteria for heart transplant procedures.
Main Methods:
- Review of the National Heart Transplant Study findings.
- Determination of medical reasonableness and necessity for heart transplants.
Main Results:
- Heart transplantation is now covered by Medicare.
- Coverage is contingent upon adherence to facility and patient selection criteria.
Conclusions:
- Heart transplants are deemed a medically reasonable and necessary service under defined conditions.
- This notice rescinds HCFA Ruling HCFAR 80-1 and implements a new coverage policy.
Abstract:
This notice extends Medicare coverage to heart transplantations when furnished by participating facilities that meet specific criteria, including patient selection criteria. We are extending coverage to heart transplants based on the results of the National Heart Transplant Study and our subsequent determination that heart transplants are a medically reasonable and necessary service when specific criteria are met. Because the HCFA Ruling HCFAR 80-1 excluded heart transplants from coverage under that Medicare program, we are issuing this notice as a new HCFA ruling. It will rescind HCFAR 80-1 and set forth the new coverage policy for heart transplants.