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Below is a list of third-party coverage policies and approvals. CryoLife, Inc. strongly recommends that you consult your payers for interpretation of pertinent coding, coverage, and reimbursement policies. FDA approval granted for TMR performed with the Cardiogenesis TMR System, February 1999.
Medicare National Coverage Determinations Manual, CMS Pub. No. 100-03, Chap. 1, Part 1, § 20.6 authorizes performance of TMR by properly trained staff at hospitals with dedicated cardiac care units for patients meeting specified characteristics.
Blue Cross Blue Shield
Blue Cross Blue Shield Association Technology Evaluation Center concludes that TMR “improves net health outcomes” and meets criteria for reimbursable therapy, January 1999 and that TMR+CABG “improves net health outcomes” and meets criteria for reimbursable therapy, May 2001.
Humana Coverage Policy authorizes reimbursement for TMR for PPO, HMO, Medicare & Medicaid HMOs, January, 2000.
Aetna US Heathcare Coverage Policy authorizes reimbursement for TMR for all plans, 2000.
Cigna Coverage Policy authorizes reimbursement for TMR for all plans, 2000.
Tricare Policy Manual Update, August 2002.
Information last updated January 2010.