The Service Line

CMS put a number on nine months of cardiology’s loudest coverage fight this week, and the multidisciplinary heart team survived it intact. The Centers for Medicare and Medicaid Services (CMS) closed its reconsideration of the National Coverage Determination (NCD) for transcatheter aortic valve replacement (TAVR) on September 10, 2026. The agency dropped the Coverage with Evidence Development (CED) registry requirement for symptomatic severe aortic stenosis, the population that drives nearly all TAVR volume, while extending coverage to asymptomatic severe aortic stenosis only inside approved CED studies. It also scrapped hospital-level procedural volume minimums in favor of infrastructure and quality-process standards, but kept an operator-level floor (at least 20 transcatheter cardiac valve procedures a year, 15 or more of them TAVR, or 40 such procedures over two years with 30 or more TAVR) and preserved the multidisciplinary heart team, defined as at least one cardiac surgeon and one interventional cardiologist, that cardiac surgery groups had lobbied hardest to protect. The Society of Thoracic Surgeons said the final policy “does not incorporate all of STS’ recommendations regarding cardiac surgeon involvement and expanded evidence development,” while the Society for Cardiovascular Angiography and Interventions called it “important steps to support patient access while maintaining a focus on quality.” Confidence: High on the decision’s substance and date; Medium on how quickly TAVR programs without on-site cardiac surgery respond. CMS TAVR decision memo · STS on the final NCD · SCAI final TAVR NCD summary.

Reimbursement

The American College of Cardiology asked CMS to delay its mandatory heart-failure payment model and reverse double-digit cuts to structural and imaging procedures. The American College of Cardiology (ACC) filed formal comments on the Calendar Year (CY) 2027 Medicare Physician Fee Schedule proposed rule on September 10, 2026, ahead of the September 14 comment deadline. ACC asked CMS to postpone the January 1, 2027 start of the mandatory Ambulatory Specialty Model (ASM) for heart failure and make its first year a no-risk educational period, citing low confidence that participants can control costs driven by clinicians outside their own practices and barriers to getting timely claims data. The letter also opposes proposed cuts that diverge from the American Medical Association’s Relative Value Scale Update Committee recommendations: roughly a 10 percent reduction to left atrial appendage closure (Current Procedural Terminology code 33340), cuts of more than 28 percent to newly created tricuspid valve repair codes, a 19.5 percent cut to drug-coated balloon angioplasty, and reductions of 20 to 25 percent to coronary intravascular ultrasound. Confidence: High on the letter’s contents; Medium on which asks CMS adopts before the rule finalizes, typically in November. ACC’s CY2027 fee schedule comments.

Enforcement

No new cardiology-specific settlement broke this window; the compliance thread to watch is remote monitoring billing, a code family adjacent to the one our stack flags for cardiac fraud. The Department of Health and Human Services Office of Inspector General (OIG) has not published a new cardiology-specific fraud settlement since our last cycle. A different but related thread is worth tracking: OIG’s active audit of Medicare Part B remote patient monitoring billing (project OAS-25-05-008, opened December 2024, results still due sometime in 2026). That audit covers the general remote monitoring code family rather than cardiac implantable device monitoring specifically, but it follows a 2025 OIG report that found remote monitoring payments hit $536 million in 2024, up 31 percent from 2023, with the agency saying Medicare still lacks basic data on which devices and which conditions drove that growth. Cardiology practices bill into both code families; scrutiny of one has a track record of spilling into the other. Confidence: Medium. OIG remote patient monitoring audit.

Who’s Buying

A small Florida cardiology tie-up previews the “second bite” recapitalization wave private-equity-backed platforms are entering next. Clearwater Cardiovascular Consultants, the Tampa Bay practice owned by Lee Equity Partners’ Cardiovascular Logistics platform since 2023, partnered with Pasco Cardiology Center on September 4, 2026, absorbing the Trinity, Florida practice’s cardiac catheterization, pacemaker, and electrophysiology services, with two additional subspecialists expected to join in the coming months; financial terms were not disclosed. The deal itself is small, but Physician Growth Partners’ latest market read says many private-equity-backed cardiology platforms, Cardiovascular Associates of America, Cardiovascular Logistics, and US Heart and Vascular among them, are approaching their “second bite,” the point where a platform’s original sponsor sells a stake to a new investor and injects fresh capital for another acquisition run, which is why bolt-ons like this one keep landing even as headline mega-deals slow. Confidence: Medium on the deal; Medium on second-bite timing across the sector. Clearwater Cardiovascular/Pasco Cardiology announcement · Physician Growth Partners cardiology market update.

Clinical Policy

The Heart Rhythm Society says most wrongful prior-authorization denials in electrophysiology never get appealed, even though most denials that are appealed get overturned. The Heart Rhythm Society (HRS) and its advocacy arm, Heart Rhythm Advocates, published a position statement in the journal Heart Rhythm on September 17, 2026, arguing that prior authorization from Medicare Advantage and commercial insurers has become a systematic barrier to guideline-indicated electrophysiology (EP) care. The statement cites federal audit data showing a substantial share of denied prior authorization requests actually meet Medicare’s own coverage criteria and that most denials that get appealed are overturned, but says most wrongful denials are never contested at all, and it walks through denial patterns specific to catheter ablation of atrial fibrillation, implantable cardioverter-defibrillator therapy, left atrial appendage occlusion, and cardiac resynchronization therapy with defibrillation. Separately, Heart Rhythm Advocates has flagged a live example: Carelon Medical Benefits Management is reportedly treating add-on ablation work billed under CPT code 93657 as potentially not medically necessary, triggering peer-to-peer review on a code that had not previously drawn it. Confidence: High on the position statement’s publication and claims; Medium on how much practical leverage it gives EP practices against individual payer denials. HRS/Heart Rhythm Advocates position statement.

The Operator Metric

Track your program’s number against Medicare’s new TAVR floor: 20 transcatheter valve procedures a year, at least 15 of them TAVR. CMS’s finalized TAVR coverage rule sets the operator-level bar every proceduralist doing transcatheter aortic valve replacement needs to clear to keep billing Medicare: at least 20 total transcatheter cardiac valve procedures a year with 15 or more of them TAVR, or 40 such procedures over two years with 30 or more TAVR. Hospitals no longer face a separate facility-level volume minimum, so a program’s Medicare eligibility now rides entirely on its individual operators clearing that bar rather than the site’s aggregate case count, a meaningful shift for lower-volume and newer TAVR programs that previously leaned on the hospital threshold to qualify. Confidence: High on the published thresholds; Medium on how Medicare Administrative Contractors will audit compliance without the prior registry-based CED tracking. CMS TAVR decision memo.