TL;DR: The Centers for Medicare & Medicaid Services retired NCD 73, the national coverage determination 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 in 2026.
CMS pulmonary embolectomy coverage policy no longer operates under a single national standard. The retirement of NCD 73 in the CMS Medicare system means your MAC — not a federal NCD — now controls whether TPE is covered for your patients. This policy carries no specific CPT or HCPCS codes in the retirement document itself. But the absence of a national rule creates real exposure if your team hasn't updated its local coverage determination process.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Transvenous (Catheter) Pulmonary Embolectomy — RETIRED |
| Policy Code | NCD 73 |
| Change Type | Modified (Retirement) |
| Effective Date | October 28, 2021 (retirement); NCD revision issued March 9, 2023 |
| Policy Key | 73-v3 |
| Impact Level | Medium — ongoing exposure for teams billing TPE without checking MAC-level LCD |
| Specialties Affected | Interventional radiology, vascular surgery, cardiology, pulmonology |
| Key Action | Contact your MAC to confirm current local coverage determination for TPE before submitting claims |
CMS Transvenous Pulmonary Embolectomy Coverage Criteria and Medical Necessity Requirements 2026
This is the core of what changed. The Centers for Medicare & Medicaid Services removed NCD 73 — the national coverage determination governing transvenous (catheter) pulmonary embolectomy — effective October 28, 2021. The formal retirement notice was issued March 9, 2023, with an implementation date of April 10, 2023.
Before the retirement, NCD 73 set a single national standard for whether TPE was covered under Medicare. Every MAC followed the same federal rule. That's gone now.
Under section 1862(a)(1)(A) of the Social Security Act, coverage decisions default to your MAC when no NCD governs a procedure. That means medical necessity determinations for TPE are now made at the regional level. Two providers in different MAC jurisdictions can get opposite coverage results for the same procedure on the same patient profile.
This creates a real prior authorization and documentation problem. Without a national rule, your billing team can't assume a prior authorization approval in one jurisdiction means anything about coverage in another. Check your MAC's local coverage determination before you submit.
The CMS transvenous pulmonary embolectomy coverage policy no longer tells you whether the procedure meets medical necessity. Your MAC does. If your MAC hasn't published a local coverage determination for TPE, coverage falls under contractor discretion — which means your claim could go either way.
Coverage Indications at a Glance
The retired NCD 73 does not contain active coverage indications — the national standard was removed entirely. The table below reflects the current coverage framework post-retirement.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Transvenous (Catheter) Pulmonary Embolectomy — all indications | No longer governed by NCD | No codes specified in NCD 73 retirement document | Coverage determined by MAC under section 1862(a)(1)(A) of the Social Security Act |
| TPE in MAC jurisdictions with an active LCD | Covered per LCD criteria | Refer to applicable MAC LCD | Medical necessity criteria vary by jurisdiction |
| TPE in MAC jurisdictions without an active LCD | Contractor discretion | Refer to applicable MAC | Denial risk is elevated without an LCD in place |
CMS Transvenous Pulmonary Embolectomy Billing Guidelines and Action Items 2026
The retirement of NCD 73 doesn't eliminate your billing obligations — it shifts where the rules come from. Here's what to do now.
| # | Action Item |
|---|---|
| 1 | Identify your MAC and pull its current LCD for TPE. Go to the CMS MCD (Medicare Coverage Database) and search your MAC's published local coverage determinations. If no LCD exists for transvenous pulmonary embolectomy billing in your jurisdiction, document that gap in your compliance files. |
| 2 | Stop applying the old NCD 73 criteria to claims. The effective date of the retirement is October 28, 2021. If your charge capture or billing guidelines still reference NCD 73 as an active policy, update them now. Using a retired NCD as the basis for a coverage determination creates claim denial risk. |
| 3 | Build MAC-specific medical necessity documentation into your workflow. Since medical necessity is now a local standard, your clinical documentation needs to align with what your MAC requires — not a national template. Work with your medical director to update your TPE documentation checklist. |
| 4 | Audit any open or pending TPE claims for MAC alignment. If you have claims in the pipeline that were prepared under the assumption of a national NCD, review each one against your MAC's current position. A claim denial on a TPE case can be substantial — transvenous catheter procedures carry real reimbursement exposure. |
| 5 | Set a calendar reminder to re-check your MAC's LCD annually. MACs update and publish new local coverage determinations on their own schedules. A MAC that has no LCD today could publish one in 2026. Assign someone on your billing team to check quarterly. |
| 6 | If you operate across multiple MAC jurisdictions, build a jurisdiction-specific coverage matrix. TPE billing guidelines now differ by region. A multi-site practice needs a current MAC coverage map for this procedure. If you're unsure how to structure this, talk to your compliance officer before the next claim goes out. |
| 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 policy document for NCD 73 (73-v3) does not list specific CPT, HCPCS, or ICD-10 codes. This is consistent with a retirement notice — the NCD was removed, not replaced with new code-level coverage criteria.
What This Means for Transvenous Pulmonary Embolectomy Billing
The absence of codes in the NCD retirement document is not a coverage gap — it's a structural shift. Code-level coverage criteria now live at the MAC level, in each contractor's local coverage determination. Your MAC's LCD (or lack of one) is where you'll find the specific procedure codes and diagnosis codes that determine reimbursement.
Check the following MAC portals for current LCD policies governing catheter-based pulmonary embolectomy procedures:
- Noridian (Jurisdictions E and F)
- CGS Administrators (Jurisdictions 15 and J)
- Palmetto GBA (Jurisdictions J and M)
- WPS Government Health Administrators (Jurisdictions 5 and 8)
- First Coast Service Options (Jurisdiction N)
- Novitas Solutions (Jurisdictions H and L)
- NGS (National Government Services) (Jurisdictions K and 6)
- Molina Healthcare (Jurisdiction 4)
Search the CMS Medicare Coverage Database at cms.gov for "pulmonary embolectomy" filtered by your MAC to find current LCD and article-level billing guidance.
The Real Issue With This Retirement
Here's the thing about NCD retirements that billing teams often miss: the absence of a national rule isn't neutral. It creates variability. And variability creates claim denial exposure.
When NCD 73 was active, you had a single answer. Now you have up to eight different answers depending on which MAC processes your claim. That's not a simplified system — it's a more complex one, just distributed differently.
The procedures involved here — catheter-based pulmonary embolectomy, a technique for removing clots from the pulmonary arteries — are not low-volume outliers in cardiology and interventional radiology settings. These are real claims with real reimbursement dollars attached. And without an NCD, your billing team carries more of the research burden.
The March 9, 2023 issuance date and April 10, 2023 implementation of the formal retirement notice are significant. If your team hasn't revisited your TPE billing process since 2023, you're operating on a framework that no longer reflects current CMS policy. Get your MAC's current position in writing before the next claim goes out.
If you're billing across jurisdictions and you're not certain how each of your MACs handles TPE medical necessity, loop in your compliance officer. The variation here is large enough that a single wrong assumption could affect a meaningful number of claims.
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