Ventricular Assist Devices

TRICARE covers ventricular assist devices (VADs) (external and implantable) if the device is approved by the Food and Drug Administration (FDA) and used in accordance with FDA-approved indications.

The procedure must be performed at one of the following facilities:

• TRICARE-certified heart transplantation center
• TRICARE-certified pediatric consortium heart transplantation center
• Medicare facility approved for VAD implantation as destination therapy

Patients must meet all of the following conditions to qualify:

• Chronic end-stage heart failure
• Not a candidate for heart transplantation
• Class IV heart failure symptoms have failed to respond to optimal medical management for at least 60 of the last 90 days.
• Left Ventricular Ejection Fraction (LVEF) less than 25%
• Functional limitation with a peak oxygen consumption of less than 12 ml/kg/min; or the patient has a continued need for intravenous inotropic therapy owing to symptomatic hypotension, decreasing renal function, or worsening pulmonary congestion.
• Appropriate body size (by device per FDA labeling) to support the VAD implantation.