The Service Line

Medicare is weighing whether to cover transcatheter valve replacement for patients with a leaking aortic valve, opening the review weeks after it finalized its broader aortic valve rule. The Centers for Medicare and Medicaid Services (CMS) lists a new national coverage analysis, “Transcatheter Aortic Valve Replacement (TAVR) for Aortic Regurgitation (AR)” (file CAG-00430R3), as open in its Medicare Coverage Database, last updated September 14. Trade reporting puts the public comment close at October 10 and a proposed decision due by March 10, 2027; we could not open CMS’s tracking sheet directly, so treat those two dates as reported, not confirmed. Today, TAVR devices are built and covered around narrowing of the valve (stenosis), not leakage (regurgitation), so a favorable decision would open a new patient pool for structural heart programs. It follows CMS’s September 10 final decision on the main TAVR rule, which ended the evidence-development requirement for symptomatic severe stenosis. Structural programs should start modeling referral volume now, but no coverage exists until a final decision, likely mid-2027. Confidence: High that the review is open; Medium on the dates and Low on the outcome. CMS Medicare Coverage Database, TAVR for aortic regurgitation analysis

Reimbursement

The proposed 2027 physician fee schedule cuts work values on several cardiology procedures by 10 to 28 percent, on top of a lower Medicare base rate. The American College of Cardiology (ACC) says CMS proposes cutting the physician work value of the new tricuspid valve repair and replacement codes by more than 28 percent from what the American Medical Association’s valuation committee recommended, trimming left atrial appendage closure (33340) by 10 percent, cutting coronary intravascular ultrasound by 20 to 25 percent, and valuing the new drug-coated balloon code at the 25th percentile rather than the median. The conversion factor, the dollar multiplier applied to every relative value unit, would fall to $32.8409 for most clinicians (from $33.4009) and to $33.1693 for those in qualifying alternative payment models (from $33.5675). The 2.5 percent “efficiency adjustment” from the 2026 rule would stay. ACC projects overall cardiovascular payment up about 1 percent, but that is an average: a structural or vascular lab can land well below it. Last year’s final rule appeared October 31, so the final numbers could arrive within days. Confidence: High on the proposed values; Medium on timing of the final rule. ACC summary of the CY2027 physician fee schedule proposed rule

The proposed rule would also let some wrongly assigned cardiologists out of the mandatory heart-failure payment model, but only if the exception becomes final. CMS proposes exceptions to the Ambulatory Specialty Model (ASM), which starts January 1, 2027, for participants who formally redesignate into a heart-failure-excluded subspecialty and for those who change tax identification number (TIN). Participants with an outdated specialty designation should update their Medicare enrollment through PECOS or form CMS-855 now. The proposal also lets multiple participants under one TIN sign a single collaborative care agreement with a primary care practice, and would drop the “established patient” requirement for shared beneficiaries. ACC says the heart-failure readmission measure would be scored at the individual TIN and NPI level. An electronic prior authorization measure would be voluntary in 2027 and required in 2028. Confidence: High on the proposal; Low on whether it survives to the final rule unchanged. ACC summary of proposed ASM updates · CMS Ambulatory Specialty Model page

Enforcement

No new cardiology-specific Department of Justice or Office of Inspector General action surfaced this window. Searches found the most recent cardiology False Claims Act settlement we could date was the March 2026 Tri-City Cardiology vein ablation resolution, nothing dated October. We will flag any new action the day it posts.

Who’s Buying

No new cardiology practice acquisition or payer partnership dated this window could be confirmed against a primary source. Trade coverage describes the large private-equity cardiology platforms as approaching a “second bite” recapitalization phase, but no new announced close surfaced this week.

Clinical Policy

The Transcatheter Cardiovascular Therapeutics meeting opens Saturday with 28 late-breaking studies, several of which bear directly on coverage. The TCT program in San Diego (October 31 to November 3) includes PROGRESS, a randomized trial of TAVR versus clinical surveillance for moderate aortic stenosis (Monday, in the New England Journal of Medicine session); the economic analysis of EARLY TAVR in asymptomatic severe stenosis (Sunday); SPYRAL AFFIRM, a post-approval study of Medtronic’s renal denervation system (Tuesday); and PIONEER IV, angiography-derived fractional flow reserve versus usual care in PCI (Tuesday). A positive PROGRESS result would push the next TAVR coverage fight toward moderate disease. Results are not out yet, so plan your calendar, not your budget, around them. Confidence: High on the schedule; no result claims are made. TCTMD preview of TCT 2026

The Operator Metric

About 11.5 percent: the combined proposed cut to the work portion of left atrial appendage closure (33340) once the lower conversion factor is applied. The ACC reports a 10 percent proposed work value cut to code 33340, and the conversion factor falls 1.68 percent for most clinicians; compounding the two gives roughly an 11.5 percent drop in the work component’s dollars (our arithmetic, not CMS’s, and it excludes practice expense and malpractice components, so total payment moves less). Run your own 2027 numbers in the ACC proposed-rule calculator before the final rule posts. Confidence: High on inputs; Medium on the blended effect. ACC summary of the CY2027 physician fee schedule proposed rule