Update from Medical Technical Advisory Committee (MTAC)
Posted on September 9, 2024
Percutaneous hemodialysis arteriovenous (AV) fistulas are created using endovascular techniques without the need for a surgical incision and are also termed endo-AV fistulas or endoAVFs.
36836 describes the Ellipsys Vascular Access System. Under high frequency ultrasound guidance, an outer access cannula, guidewire, and vessel capture construct creates a connection of the vein to the artery intravascularly. Low power thermal energy is used to cut the walls of the vessels and fuse the tissue, creating a permanently fused anastomosis without leaving any foreign material in the resulting AVF.
36837 describes the WavelinQ. Per Hayes, an arterial catheter is inserted into the ulnar artery via the brachial artery, and the venous catheter is inserted into the ulnar vein via the brachial vein. The catheters are aligned, and the magnets hold the artery and vein together. The RF electrode is released from the venous catheter and energized for approximately 2 seconds. This creates an anastomosis between the ulnar vessels, resulting in a side-to-side ulnar vein fistula in the arm. If the patient has more than 1 brachial vein, the entry brachial vein is coil-embolized to redirect flow to the superficial veins.
Research: Hayes, with literature update until 2021, both are considered E&I due to limited poor quality evidence. Additional searching found no new high quality evidence published. Indication is very narrow, not completely fail-safe proof. Procedure reviewed by MRIoA with a determination this procedure is standard of care. It appears that the industry standard is that payers cover with no PA. Decision to remove PA for procedure and make it covered for Commercial and Medicare Advantage. The codes are non-payable for MassHealth at this time.
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