TL;DR: The Centers for Medicare & Medicaid Services retired NCD 73 for Transvenous (Catheter) Pulmonary Embolectomy, effective October 28, 2021. Coverage decisions now fall to individual Medicare Administrative Contractors. Here's what that means for your billing team.
CMS pulmonary embolectomy coverage policy no longer exists at the national level. The Centers for Medicare & Medicaid Services officially removed NCD 73 — the National Coverage Determination governing transvenous (catheter) pulmonary embolectomy — from the Medicare NCD database effective October 28, 2021. A formal revision notice followed on March 9, 2023. The policy now carries a "RETIRED" designation, and coverage determinations have shifted entirely to your regional Medicare Administrative Contractor. No specific CPT or HCPCS codes are listed in this policy document.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS / Medicare |
| Policy | Transvenous (Catheter) Pulmonary Embolectomy (TPE) — RETIRED |
| Policy Code | NCD 73 |
| Change Type | Modified (Retired) |
| Effective Date | October 28, 2021 (revision notice: March 9, 2023; updated policy key: 2026-03-07) |
| Impact Level | High — national coverage standard removed; regional variability now applies |
| Specialties Affected | Interventional Radiology, Interventional Cardiology, Vascular Surgery, Pulmonology, Hospital Billing |
| Key Action | Contact your MAC to get the current local coverage determination for TPE before submitting claims |
CMS Transvenous Pulmonary Embolectomy Coverage Criteria and Medical Necessity Requirements 2026
NCD 73 in the CMS Medicare system was the national rule that governed whether transvenous (catheter) pulmonary embolectomy qualified for Medicare reimbursement. That rule is gone. CMS retired it on October 28, 2021, under Section 1862(a)(1)(A) of the Social Security Act.
What replaced it? Nothing at the national level. That's the real issue here.
When CMS retires an NCD without issuing a replacement, coverage decisions fall to Medicare Administrative Contractors. Each MAC can now build its own local coverage determination — or not build one at all. Your MAC may cover TPE broadly, cover it only under narrow medical necessity criteria, or have no formal LCD in place yet.
The practical effect: medical necessity determinations for TPE are now made regionally, not nationally. A claim that sails through in one MAC jurisdiction may get denied in another. Your billing team cannot assume uniform coverage across your patient population, especially if your practice operates across multiple states or MAC regions.
Whether prior authorization applies also depends on your MAC's policies. The retired NCD 73 says nothing about prior authorization requirements — that determination now lives entirely with your regional contractor. Check your MAC's current LCD or coverage article before you submit.
CMS Transvenous Pulmonary Embolectomy Exclusions and Non-Covered Indications
The retired NCD 73 does not list specific exclusions, non-covered indications, or experimental designations. The document contains no clinical criteria at all — it simply states that the NCD has been removed.
That absence is itself a risk. Without a national coverage policy defining what is and isn't covered, your MAC's local rules become the only guidance. If your MAC has not issued an LCD for TPE, you're operating without a clear coverage framework. That creates real claim denial exposure.
The safest position: treat TPE coverage as unconfirmed until you verify your MAC's current stance in writing. Don't rely on past approval history from before October 2021 as evidence of current coverage.
Coverage Indications at a Glance
Because NCD 73 has been retired and no replacement NCD exists, there are no nationally defined coverage indications to summarize. The table below reflects the current state of national Medicare coverage policy for TPE.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Transvenous (Catheter) Pulmonary Embolectomy — all indications | No national coverage determination | Not specified in policy | Coverage determined by MAC via LCD or individual claim review under Section 1862(a)(1)(A) |
If you need a working coverage framework, go directly to your MAC. Noridian, Novitas, CGS, Palmetto GBA, and the other MACs may each have a different standard. Some may have an active LCD; others may review TPE claims on a case-by-case basis.
CMS Transvenous Pulmonary Embolectomy Billing Guidelines and Action Items 2026
This retirement has been in effect since October 2021. If your team has been billing TPE without verifying MAC-level coverage, that's a gap you need to close now. The 2026-03-07 policy update refreshed the record, which means CMS is actively maintaining this retired status — it's not going away.
| # | Action Item |
|---|---|
| 1 | Identify your MAC and pull their current LCD for TPE. Go to the CMS Coverage Database and search your MAC's local determinations. If no LCD exists, contact your MAC's Provider Relations line directly and ask how they handle TPE claims. |
| 2 | Stop relying on the retired NCD 73 as coverage authority. It provides no clinical criteria and no coverage guarantee. Any claim submitted with the assumption that a national standard applies will expose you to denials the moment your MAC's rules don't align. |
| 3 | Document medical necessity at the claim level, not the policy level. Since there's no NCD to point to, your supporting documentation carries all the weight. Attach detailed operative notes, physician orders, and clinical justification with every TPE claim. |
| 4 | Ask your MAC whether prior authorization is required. The retired NCD is silent on prior auth. Your MAC's LCD or billing guidelines may require it. Confirm this before services are rendered, not after. |
| 5 | Audit any TPE claims submitted since October 28, 2021. If your team was billing as though the old NCD still governed coverage, some of those claims may have gone out with incorrect or missing justification. Pull a targeted claim audit and check denial rates on TPE-related codes. |
| 6 | Flag this for your compliance officer if you have high TPE volume. The shift from national NCD to local MAC determination is a material change in your coverage framework. If TPE is a meaningful part of your revenue cycle, your compliance officer should review your current billing approach against your specific MAC's rules. Don't make that call alone. |
| 7 | Watch for MAC LCD updates. MACs publish new and revised LCDs on the Medicare Coverage Database. Set up a monitoring process for your MAC's LCD activity, particularly for interventional pulmonary and vascular procedures. |
| 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 Transvenous Pulmonary Embolectomy Under NCD 73
The retired NCD 73 does not list any CPT, HCPCS Level II, or ICD-10-CM codes. This is consistent with a retired policy — CMS removed the clinical framework, including any associated code lists, when it retired this NCD.
What This Means for Transvenous Pulmonary Embolectomy Billing
The absence of codes in this policy is not a minor administrative detail. It means there is no CMS-sanctioned code list tied to this coverage policy. Your MAC's LCD — if one exists — will specify which procedure codes apply and under what conditions.
Transvenous pulmonary embolectomy billing typically involves catheter-based intervention codes. The exact codes that apply to your claims depend on the specific technique, device, and approach used. Your MAC's LCD or billing guidelines will define which codes they accept for TPE and how they expect them to be documented.
Do not use this policy document to build a code list. Pull your coding reference from your MAC's LCD, your facility's CDM, or a current CPT/HCPCS coding resource tied to your MAC's published guidance.
A Note on the Policy Timeline
The effective date history on NCD 73 is worth understanding clearly. CMS retired the NCD on October 28, 2021. The formal revision notice — document Rev. 11892 — was issued March 9, 2023, with an implementation date of April 10, 2023. The 2026-03-07 date associated with this policy key reflects the most recent update to the policy record in the CMS system.
None of these dates change the core fact: the NCD has been retired since late 2021. The 2023 revision codified the retirement notice. The 2026 record update is administrative. The effective date of the retirement itself is October 28, 2021.
If your team is doing a retrospective audit, use October 28, 2021 as the line. Claims submitted before that date operated under the old NCD. Claims submitted after that date should have been evaluated against your MAC's local rules.
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