CMS Covers T-TEER for Tricuspid Regurgitation Under NCD 381 — What Billing Teams Need to Know

The Centers for Medicare & Medicaid Services has issued a modified coverage determination under NCD 381 that establishes national Medicare coverage for transcatheter edge-to-edge repair for tricuspid valve regurgitation (T-TEER). Effective March 12, 2026, CMS covers T-TEER under a Coverage with Evidence Development (CED) framework — meaning coverage is real, but it comes with strict enrollment, physician, and study participation requirements that your billing and credentialing teams must understand before submitting a single claim.

Field	Detail
Payer	CMS (Medicare)
Policy	Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Policy Code	NCD 381
Change Type	Modified
Effective Date	2026-03-12
Impact Level	High
Specialties Affected	Interventional Cardiology, Cardiac Surgery, Heart Failure Cardiology, Interventional Echocardiography
Key Action	Confirm your facility is enrolled in a CMS-approved CED study before scheduling T-TEER procedures for Medicare patients.

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What CMS NCD 381 Now Covers for T-TEER

Tricuspid regurgitation (TR) is a condition in which the tricuspid valve fails to close properly, causing blood to leak backward into the right atrium. T-TEER is a catheter-based repair technique that clips the valve leaflets together to reduce regurgitation without open surgery. Until this NCD, Medicare coverage for T-TEER was inconsistent across the country. NCD 381 changes that — but it doesn't open the door unconditionally.

CMS covers T-TEER under Coverage with Evidence Development, which is the agency's mechanism for extending coverage to procedures that show clinical promise but require additional long-term outcomes data. This is not experimental or investigational status — patients can receive the procedure and Medicare will pay — but both the facility and the care team must meet defined criteria and services must be furnished within a CMS-approved CED study.

The benefit categories under NCD 381 are Inpatient Hospital Services and Physicians' Services.

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CMS T-TEER Coverage Criteria: Patient, Physician, and Study Requirements

This is where the operational complexity lives. Coverage is only triggered when all three criteria categories are satisfied simultaneously.

Patient Criteria (NCD 381 Section B.1)

Medicare will cover T-TEER only for patients who meet all of the following:

#	Covered Indication Copy
1	Symptomatic tricuspid regurgitation that persists despite optimal medical therapy (OMT)
2	Tricuspid valve repair has been deemed appropriate by a multidisciplinary heart team

"Symptomatic" and "optimal medical therapy" are not defined further in the NCD summary, which means documentation of OMT failure and symptom burden will be critical for demonstrating medical necessity. Expect payer reviewers — and auditors — to look closely at chart documentation here.

Physician and Heart Team Criteria (NCD 381 Section B.2)

The patient must be under the care of a qualifying heart team both preoperatively and postoperatively. At minimum, the team must include:

All four specialists must have documented experience in the care and treatment of TR specifically. This isn't a checkbox — if you can't document each team member's relevant experience, you're at risk for a claim denial or a post-payment audit finding.

CED Study Criteria (NCD 381 Section B.3)

Every T-TEER procedure billed to Medicare must be furnished within the context of a CMS-approved CED study. The study protocol must:

The study must also be designed to support subgroup analyses across a detailed list of clinically important variables, including:

This level of subgroup granularity tells you CMS is serious about generating real-world evidence. Facilities that are sloppy about data collection will not only jeopardize future coverage — they may jeopardize reimbursement for procedures already performed.

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Non-Coverage Situations Under NCD 381

While the NCD establishes covered indications, coverage does not apply when:

• The patient has not failed optimal medical therapy
• The procedure is not performed under a CMS-approved CED study
• The heart team composition does not meet the four-specialty minimum
• The procedure is not performed according to an FDA market-authorized indication

Facilities performing T-TEER outside of an approved study, or without the complete heart team on record, should expect denials on medical necessity or coverage grounds.

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Affected Codes

The policy data for NCD 381 does not list specific CPT or HCPCS codes at this time. Billing teams should monitor the CMS Medicare Coverage Database and the National Coverage Determinations Manual for associated procedure codes as they are published. Work with your coding team to identify the appropriate Category III or Category I CPT codes for transcatheter tricuspid valve repair as CMS updates associated billing guidance.

Related ICD-10 Diagnosis Codes to Watch:

Code	Description Copy
I07.1	Tricuspid insufficiency (regurgitation)
I07.8	Other tricuspid valve diseases
I07.9	Tricuspid valve disease, unspecified

Note: These ICD-10 codes reflect standard clinical coding for TR and are not explicitly enumerated in NCD 381. Confirm with your coding team prior to claim submission.

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What Your Billing Team Should Do

Copy Action Items

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