Reimbursement C-Codes

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Coding Resources

We have compiled the structural heart disease product coding documents and references you need most. Print, save or bookmark these resources for quick reference.

In addition, we hold webcasts addressing reimbursement questions. Contact our health care economics department for more information by emailing hce@sjm.com.

Structural heart information

Physician and hospital coding and payment information for congenital and vascular procedures:
PDF 2017 St. Jude Medical Therapy Coding Guide: Congenital and Vascular (99kb)

Physician and hospital coding and payment information for structural heart procedures:
PDF 2017 St. Jude Medical Therapy Coding Guide: Surgical Heart Valves (79kb)

Physician and hospital coding information for PFO Occluder procedures:
PDF 2017 St. Jude Medical Reimbursement Guide: AMPLATZER™ PFO Occluder (49kb)

Letter template for request for prior authorization of transcatheter PFO closure:
PDF Letter of Medical Necessity—Template to Be Considered for Prior Authorization by Physicians (160kb)

Letter template for appeal of denied claim or pre-authorization of transcatheter PFO closure:
PDF Letter of Appeal—Template to Be Considered When Requesting Reconsideration of a Denied Claim or Pre-Authorization (158kb)

Summary of clinical evidence for PFO closure with the AMPLATZER™ PFO occluder:
PDF Patent Foramen Ovale Closure With the AMPLAZTER™ PFO Occluder for Secondary Stroke Reduction of Risk in Patients With Cryptogenic Stroke: Summary of Clinical Evidence (81.8kb)

Checklist of clinical documentation for diagnosis of cryptogenic ischemic stroke:
PDF Clinical Documentation Checklist: Diagnosis of Cryptogenic Ischemic Stroke (52kb)


*Disclaimer: This webpage and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal reimbursement, business, clinical or other advice. Furthermore, it does not constitute a representation or guarantee of reimbursement, and it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by St. Jude Medical regarding reimbursement or payment amounts, or that reimbursement or other payment will be received. The ultimate responsibility for obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial or reimbursement specialist for any questions related to billing, reimbursement or any related issue. This information does not guarantee coverage or payment at any specific level, and St. Jude Medical does not advocate or warrant the appropriateness of the use of any particular code. This update reproduces information for reference purposes only. It is not provided or authorized for marketing use.