TL;DR: The Centers for Medicare & Medicaid Services modified NCD 267 governing CMS thoracic electrical bioimpedance coverage policy, with a policy revision date of January 9, 2026. This update clarifies covered and non-covered indications that your billing team needs to know before submitting claims.
The original TEB coverage determination — effective July 1, 1999 — was vague enough that practitioners couldn't reliably predict what would get paid. CMS revised NCD 267 in response to a formal reconsideration request, replacing broad language with explicit covered indications, hard exclusions, and a carve-out for Medicare Administrative Contractor discretion on drug-resistant hypertension. This policy does not list specific CPT or HCPCS codes, which creates its own billing challenge — covered below.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB) |
| Policy Code | NCD 267 |
| Change Type | Modified |
| Effective Date | 2026-01-09 |
| Impact Level | Medium — affects cardiology, CHF management, heart transplant, and pacemaker optimization billing |
| Specialties Affected | Cardiology, Heart Failure Management, Cardiac Surgery, Transplant Medicine, Hypertension Management |
| Key Action | Audit active TEB claims against the five covered indications and four hard exclusions before submitting to Medicare |
CMS Thoracic Electrical Bioimpedance Coverage Criteria and Medical Necessity Requirements 2026
The core issue with TEB billing has always been documentation. CMS said as much when it revised this policy — the old language wasn't specific enough to tell practitioners when Medicare would actually pay. The revised NCD 267 fixes that by listing exactly five covered uses and four non-covered patient populations.
Medical necessity under NCD 267 requires two things in most covered indications. First, medical history, physical examination, and standard assessment tools must be insufficient. Second, the treating physician must document that TEB hemodynamic data are necessary for appropriate patient management. If your documentation doesn't address both points explicitly, expect a claim denial.
The five nationally covered indications are:
| # | Covered Indication |
|---|---|
| 1 | Acute dyspnea differentiation — distinguishing cardiogenic from pulmonary causes when standard workup falls short |
| 2 | Pacemaker A/V interval optimization — for patients with A/V sequential pacemakers when standard assessment is insufficient |
| 3 | Continuous inotropic therapy monitoring — for terminal congestive heart failure patients receiving care at home, or patients waiting at home for a heart transplant |
| 4 | Heart transplant rejection evaluation — as a predetermined alternative to myocardial biopsy; if a biopsy is later performed, medical necessity for that biopsy must be documented separately |
| 5 | CHF fluid management optimization — when standard assessment tools don't provide enough information and the physician documents TEB as necessary |
The "predetermined alternative to biopsy" language in indication four is worth flagging to your medical director. If TEB is used first and a biopsy follows, you need a separate medical necessity statement for the biopsy. Without it, the biopsy claim is exposed.
The coverage policy ties reimbursement directly to documentation. There's no prior authorization requirement listed in NCD 267 — but the absence of a prior auth requirement doesn't lower the bar on documentation. It raises it. Payers use medical necessity review on the back end when there's no front-end prior authorization gate.
CMS Thoracic Electrical Bioimpedance Exclusions and Non-Covered Indications
CMS draws four hard lines in NCD 267. These aren't gray areas. These are patients for whom TEB is nationally non-covered, regardless of physician judgment.
Non-covered patient populations:
| # | Excluded Procedure |
|---|---|
| 1 | Severe aortic regurgitation — proven or suspected disease involving severe regurgitation of the aorta |
| 2 | Minute ventilation sensor pacemakers — the TEB device can interfere with MV sensor pacemaker function, making this a safety-based exclusion |
| 3 | During cardiac bypass surgery — TEB is excluded in this setting entirely |
| 4 | Hypertension management — all forms of hypertension are non-covered, with one exception |
The hypertension carve-out matters for practices treating complex hypertension patients. CMS excludes hypertension broadly but gives Medicare Administrative Contractors discretion for drug-resistant hypertension cases. Drug-resistant hypertension has a specific definition here: failure to reach goal blood pressure in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic. If your patient doesn't meet that definition precisely, TEB for hypertension is non-covered.
The MAC discretion element means coverage for drug-resistant hypertension is not uniform across the country. Your local MAC may cover it — or may not. Check your MAC's local coverage determination before billing TEB for any hypertension indication. This is exactly the kind of regional variation that creates billing exposure if you assume national policy is the whole story.
The catch-all matters too: "All other uses of TEB not otherwise specified remain non-covered." If an indication isn't on the five covered list, it's excluded. There's no ambiguity zone.
Coverage Indications at a Glance
| Indication | Status | Notes |
|---|---|---|
| Acute dyspnea — differentiating cardiogenic from pulmonary cause | Covered | Requires insufficient standard assessment + physician determination that TEB is necessary |
| A/V interval optimization for A/V sequential pacemakers | Covered | Requires insufficient standard assessment + physician determination that TEB is necessary |
| Continuous inotropic therapy monitoring — terminal CHF at home | Covered | Patient must be in terminal CHF, receiving care at home or waiting at home for transplant |
| Heart transplant rejection evaluation — alternative to biopsy | Covered | Must be predetermined alternative to biopsy; separate medical necessity required if biopsy later performed |
| CHF fluid management optimization | Covered | Requires insufficient standard assessment + physician determination that TEB is necessary |
| Severe aortic regurgitation (proven or suspected) | Not Covered | Hard national exclusion |
| Minute ventilation sensor pacemaker patients | Not Covered | Safety-based hard exclusion |
| During cardiac bypass surgery | Not Covered | Hard national exclusion |
| All forms of hypertension (general) | Not Covered | Blanket exclusion with one exception below |
| Drug-resistant hypertension | MAC Discretion | Coverage varies by region; must meet specific three-drug regimen definition; check your local MAC LCD |
| All other uses not listed above | Not Covered | CMS catch-all non-coverage language |
CMS Thoracic Electrical Bioimpedance Billing Guidelines and Action Items 2026
The revised NCD 267 is clearer than its predecessor — but clearer doesn't mean simple. Here's what your billing team needs to do now.
| # | Action Item |
|---|---|
| 1 | Audit your active TEB claims and pending submissions against the five covered indications. The effective date for the covered indications language is January 23, 2004, which is baked into the underlying policy. But the January 9, 2026 revision reaffirms and republishes this framework. Claims submitted after this date will be evaluated under this language. Make sure every TEB claim maps to one of the five covered uses. |
| 2 | Build a documentation checklist for the three indications that require a two-part standard. Acute dyspnea, pacemaker A/V optimization, and CHF fluid management all require (a) documentation that standard assessment tools were insufficient and (b) a physician statement that TEB data are necessary. If your clinical documentation templates don't capture both elements, update them now. |
| 3 | Flag heart transplant cases where TEB precedes biopsy. Instruct your clinical team to document TEB as a "predetermined alternative to biopsy" at the time of the TEB order — not after the fact. If a biopsy follows, generate a separate medical necessity note for the biopsy before submitting that claim. Missing this step creates denial risk on both claims. |
| 4 | Contact your MAC before billing TEB for any hypertension indication. Drug-resistant hypertension is the only hypertension exception, and coverage depends entirely on your MAC's local policy. Pull your MAC's local coverage determination. If no LCD exists for this indication in your region, assume non-coverage and consult your compliance officer before submitting. |
| 5 | Know that NCD 267 lists no specific CPT or HCPCS codes. This policy does not include a code list, which means TEB billing relies on whatever code your practice currently uses for this service. Verify with your billing consultant that your current charge capture code for TEB is supported by your payer's fee schedule and is consistent with how other providers bill this service. An unlisted or mismatched code will trigger a denial regardless of how good your documentation is. |
| 6 | Do not bill TEB for the four excluded patient populations. Severe aortic regurgitation, MV sensor pacemaker patients, bypass surgery patients, and general hypertension patients are all nationally non-covered. No amount of documentation overcomes a hard national exclusion. If one of these cases gets to your billing queue, it should be caught before claim submission — not at denial. |
If your practice sees a high volume of CHF, transplant, or complex hypertension cases, talk to your compliance officer about how NCD 267 interacts with your current documentation workflows. The financial exposure on TEB claims is real, and the criteria are detailed enough that documentation gaps are the most likely source of denials.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Thoracic Electrical Bioimpedance Under NCD 267
Applicable Billing Codes
NCD 267 does not list specific CPT, HCPCS Level II, or ICD-10-CM codes in the policy document. This is a meaningful gap for TEB billing.
Without an explicit code list from CMS, your billing team should:
- Verify the code your practice currently uses for TEB against your MAC's fee schedule
- Confirm with your billing consultant or coding team that the code is appropriate for the specific covered indication being billed
- Check whether your MAC has issued a companion LCD that includes specific codes for TEB services
The absence of codes in the NCD doesn't mean TEB is unbillable. It means code selection falls entirely on your practice, and code selection errors become your liability. A mismatched code against the wrong diagnosis will produce a claim denial that has nothing to do with whether the service was clinically appropriate.
If you're unsure which code applies to your TEB service line, loop in your billing consultant before the next claim submission cycle.
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