CommercialPrior AuthMedium impact
Transcatheter Mitral Valve Repair
Blue Cross Blue Shield of Rhode Island·RI · Cardiology, Cardiothoracic Surgery·Physician / Facility
Effective date
Nov 1, 2018
We identified it
Jun 20, 2026
Summary
Effective November 1, 2018, Transcatheter Mitral Valve Repair procedures now require prior authorization for Commercial insurance products through the online authorization tool. The procedure remains medically necessary for BlueCHiP Medicare patients when performed as part of CMS-approved clinical trials.
Action Required
Before November 1, 2018: Billing team must update system to require prior authorization for Transcatheter Mitral Valve Repair procedures for all Commercial insurance patients. Configure online authorization tool access. Providers must obtain prior auth before scheduling procedures or claims will be denied. Medicare patients in CMS-approved trials do not require prior auth.