How Heart Specialists Benefit from Medicare’s TAVR Restrictions

InnovationHealthcareHow Heart Specialists Benefit from Medicare’s TAVR RestrictionsBySue Peschin,Contributor.Forbes contributors publish independent expert analyses and insights. Sue Peschin, MHS, focuses on healthy aging and fair access to care. Follow AuthorJun 08, 2026, 09:28pm EDT--:-- / --:--This voice experience is generated by AI. Learn more.This voice experience is generated by AI. Learn more.For 14 years, patient access to TAVR has been restricted for Medicare beneficiaries under a Coverage with Evidence Development requirement by CMS. This could change by June 15.shefkate - stock.adobe.comBy June 15, Medicare is expected to announce a coverage decision impacting access for millions of seniors to a less-invasive procedure for a common type of heart valve disease. The procedure, called transcatheter aortic valve replacement, is preferred by patients because it avoids open-heart surgery and allows quicker treatment and recovery. It also reduces first-year health care costs by about $10,000 per patient for Medicare and taxpayers.The decision will be significant because, for 14 years, patient access to TAVR has been restricted under a Coverage with Evidence Development requirement by the Centers for Medicare & Medicaid Services—the federal agency that runs Medicare. Under CEDs, Medicare denies coverage for a newer, FDA-approved treatment except when beneficiaries participate in limited clinical trials or other studies. The CED policies also place strict rules on which doctors and hospitals qualify to participate in the CED trials and studies, which further constrain access. Considering how restrictive these policies are, it’s not surprising that they impact access to care for millions of beneficiaries annually. Over the past two decades, CMS has applied CED to more than 30 treatments and tests for certain cancers, sickle cell disease, and severe hearing loss (cochlear implants), among other conditions. In April 2022, Medicare even applied the policy to an e...