Cardiology reimbursement alerts

Hemangeol (propranolol hydrochloride) is an oral solution approved under NDA205410 as a new formulation for an orphan indication, billing through Medicare Part D as a self-administered oral drug. As a

Leqvio (inclisiran) is a subcutaneously administered siRNA therapy approved for LDL-C reduction, with a confirmed Part B billing pathway reflecting its physician-office or clinic administration model.

LEROCHOL (lerodalcibep-liga), approved December 12, 2025 as a new molecular entity injectable, follows a Part B billing pathway consistent with its injectable route of administration. As a brand-new m

Inpefa (sotagliflozin) is an oral tablet approved as a new molecular entity, placing it squarely in the Part D billing pathway for Medicare outpatient prescription drug coverage. As an SGLT2 inhibitor

Tryvio (aprocitentan) is an oral endothelin receptor antagonist approved for resistant hypertension, billing through Medicare Part D as a self-administered tablet. As an oral outpatient medication, it

Furoscix (furosemide 80 mg/10 mL subcutaneous injection) received FDA approval in October 2022 as a new dosage form of furosemide for subcutaneous administration, designated under Part B given its inj

Bisoprolol fumarate and hydrochlorothiazide is an oral tablet combination of a beta-blocker and thiazide diuretic approved for hypertension, billing under Medicare Part D as a self-administered oral m

Avapro (irbesartan) is an oral angiotensin II receptor blocker approved for hypertension, billing under Medicare Part D as a self-administered tablet. As a long-genericized oral medication with numero

This active final LCD (L33560) from Wellpoint Federal governs coverage criteria for cardiovascular nuclear medicine services under both Part A and Part B, effective April 1, 2026. It defines the indic

This active final LCD from Wellpoint Federal governs coverage of Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) under Medicare Part A and Part B, effective April

This final LCD from Wellpoint Federal (L39863) establishes coverage criteria for AI-enabled CT-based quantitative coronary topography and coronary plaque analysis, effective April 1, 2026. It governs

LIPFENDRA (enlicitide decanoate) is an oral tablet approved via NDA220848, placing it squarely in the Medicare Part D billing pathway rather than Part B. As an oral drug dispensed through retail or sp

LCD L33627 establishes coverage criteria for non-invasive vascular studies under both Part A and Part B with Wellpoint Federal, effective April 1, 2026. This final, active LCD governs the medical nece

This active final LCD from Wellpoint Federal establishes coverage criteria for non-invasive fractional flow reserve (FFR) testing in ischemic heart disease, effective April 1, 2026. It governs when CT

This active final LCD from Wellpoint Federal governs coverage criteria for Percutaneous Coronary Intervention (PCI) under Medicare Part A and Part B, effective April 1, 2026. It establishes the clinic

This final LCD from Wellpoint Federal governs coverage of Transthoracic Echocardiography (TTE) under Medicare Part A and Part B, effective April 1, 2026. It establishes the indications, limitations, a

This active final LCD from Wellpoint Federal governs coverage criteria for Transesophageal Echocardiography (TEE) under both Part A and Part B, effective April 1, 2026. It establishes the indications,

Repatha (evolocumab) is a PCSK9 inhibitor approved as an injectable, supporting a Part B billing pathway for physician-administered doses. As a novel biologic at the time of approval, billing teams sh

Eliquis (apixaban) is an oral anticoagulant approved as a tablet (including a tablet for suspension formulation), which routes it through Medicare Part D for outpatient prescription coverage. As an or

Eliquis (apixaban) has received approval for a new oral suspension dosage form under NDA220073, expanding access for patients unable to swallow tablets—likely pediatric or dysphagic populations. As an

Argatroban in sodium chloride is an injectable medication that will likely receive a J-code for billing purposes under Medicare Part B. As an intravenous drug, it may also qualify for pass-through pay

This final LCD from Noridian (Jurisdictions E and F) establishes coverage criteria for temporary nontherapeutic ambulatory cardiac monitoring devices, effective August 13, 2026, across 15 western stat

This final LCD from Palmetto GBA establishes coverage criteria for temporary nontherapeutic ambulatory cardiac monitoring devices effective June 28, 2026, across seven southeastern states under Part A

This final LCD from CGS (J15) governs coverage of temporary nontherapeutic ambulatory cardiac monitoring devices in Kentucky and Ohio, effective June 28, 2026. It establishes the indications, document

The proposed Local Coverage Determination (LCD) for B-type Natriuretic Peptide (BNP) testing may significantly impact billing by clarifying coverage criteria and necessity for the test, potentially im

The proposed LCD for Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices may impact billing by providing clearer guidelines for reimbursement. This could facilitate appropriate claims submi

The proposed LCD regarding temporary nontherapeutic ambulatory cardiac monitoring devices may introduce changes in billing practices and reimbursement rates. Providers may need to update their coding

The proposed LCD for Endovascular Management of Peripheral Arterial Disease will likely supports compliance with updated rates clarity for services related to both upper and lower extremities. This change could lead to incr

The proposed LCD may impact billing for nontherapeutic cardiac monitoring devices, potentially leading to increased scrutiny during the claim process. Providers should prepare for possible denials or

The new LCD by Palmetto GBA regarding Cardiac Computed Tomography and Angiography (CCTA) has significant implications for billing practices. Providers must ensure proper documentation and alignment wi

The upcoming LCD on genetic testing for heritable thoracic aortic disease may streamline billing processes for such tests, ensuring better reimbursement for providers. This could lead to increased acc

The recent MolDX guidelines for genetic testing of heritable thoracic aortic disease by Palmetto GBA may require updates to existing billing practices. Providers will need to ensure compliance with th

The new LCD for genetic testing related to heritable thoracic aortic disease may significantly impact billing practices for related tests. Providers should prepare for changes in coding and coverage t

The implementation of this new LCD may affect billing for one-day stays associated with chest pain, potentially resulting in increased scrutiny on documentation and coding. Proper adherence to the gui

The introduction of this LCD for EKG Monitoring requires billing team review-time monitoring services. Providers will need to ensure compliance

The introduction of non-invasive fractional flow reserve (FFR) for ischemic heart disease will potentially enhance the diagnostic capabilities for cardiology providers. This may lead to increased bill

The implementation of the LCD for Transcatheter Infusion Therapy will likely influence billing practices, requiring updates to coding and documentation processes. Providers should prepare for potentia

The introduction of surveillance requirements for implantable or wearable cardioverter defibrillators (ICDs) could lead to supports compliance with updated rates workload for providers. Ensuring complia

The implementation of new Local Coverage Determination (LCD) for Transesophageal Echocardiography (TEE) is expected to streamline billing processes, potentially leading to improved reimbursement rates

The introduction of the CGS contract for Transthoracic Echocardiography (TTE) may lead to supports compliance with updated rates practices for echocardiograms. Providers should ensure compliance with the new L

The implementation of the new LCD for Cardiac Computed Tomography and Coronary Angiography may impact billing processes related to these services by establishing specific criteria for reimbursement. P

The introduction of AI-QCT and AI-CPA will enhance the diagnostic capabilities in cardiology, potentially leading to supports compliance with updated rates due to improved efficiency in coronary plaque analysis. Pro

The implementation of the Noridian LCD for Cardiovascular Stress Testing requires billing team review.

The recent LCD for cardiovascular stress testing emphasizes the necessity for compliance with updated guidelines, which may impact reimbursement. Providers must ensure correct documentation and coding

The introduction of AI-QCT and AI-CPA technology will enhance compliance updates for cardiovascular imaging services. This may lead to supports compliance with updated rates for advanced coronary plaque ana

The LCD for Echocardiography will impact billing practices starting October 23, 2025. Providers will need to stay updated on specific guidelines and documentation requirements to ensure compliance and

The implementation of the new LCD for Percutaneous Coronary Interventions will significantly impact billing practices for cardiovascular procedures. Providers must ensure compliance with the updated g

The implementation of the LCD for Coronary Computed Tomography Angiography (CCTA) may lead to increased scrutiny on claims processing and reimbursement rates. Facilities should prepare for potential c

The introduction of non-coronary vascular stents under WPS may lead to updated billing practices. Providers would need to familiarize themselves with the new coding and reimbursement policies to ensur

The new Local Coverage Determination (LCD) for electrocardiograms set to take effect on November 6, 2025, may alter the reimbursement landscape for cardiology practices. Providers should prepare for c