Effective September 10, 2026, CMS updated coverage criteria for National Coverage Determination (NCD) 20.32 through a final Decision Memo for Transcatheter Aortic Valve Replacement (TAVR). Medicare contractors received direction to follow the decision memo until NCD 20.32 is updated.

Key changes include:

• CMS issues final NCD on TAVR that removes the Coverage with Evidence Development (CED) requirements for TAVR in patients with symptomatic severe AS.
  • CED requirements ended for symptomatic severe aortic stenosis (AS).
  • Coverage was expanded to asymptomatic severe AS when furnished under a CMS-approved CED study.
• Patient evaluation requirements were revised to allow one in-person evaluation by a heart team TAVR operator and an asynchronous medical record evaluation by the other.
• Hospital procedural volume requirements were removed, while TAVR operator volume requirements were updated.
• Joint participation by an interventional cardiologist and cardiac surgeon during the TAVR procedure is no longer required. One TAVR operator may perform the procedure.
• Hospitals must maintain a continuous quality improvement process.
• MACs may make reasonable and necessary coverage determinations for other TAVR indications, including moderate AS and aortic regurgitation (AR), as well as emergency scenarios.

Claims Changes

• Modifier 62 is no longer required on all Part B TAVR claims.
• The 8-digit ClinicalTrials.gov identifier and diagnosis code Z00.6 are no longer required on all TAVR claims. However, applicable CED information remains required for asymptomatic severe AS furnished as part of a CMS-approved CED study.

Review the NCD 20.32 Decision Memo for Transcatheter Aortic Valve Replacement (TAVR).