The use of ultrafiltration (37799) is considered investigational in patients with heart failure. A participating, preferred, or network provider can bill the member for this denied service.

At this time, there is limited published evidence to evaluate the impact of this technique on clinical outcomes. The published clinical trials involve small numbers of patients and report short-term to intermediate outcomes. Based on this current information, the data do not provide sufficient information to evaluate the impact on relevant outcomes.

Description

Fluid overload is a common medical problem that can occur from a variety of causes, including renal failure, post-surgical fluid overload, metabolic disease and congestive heart failure. Patients with heart failure represent the largest group of fluid-overloaded patients. Heart failure is the progressive inability of the heart to pump enough blood to support the vital organs and often leads to a buildup of fluid, causing swollen legs and arms, fatigue, and eventually excess fluid in the lungs and severe life-threatening shortness of breath. To date, intravenous diuretics have been the standard of care to treat fluid overload.

Various approaches are being explored in treating these patients. Ultrafiltration is one technique receiving increasing publicity for a possible role in hospitalized patients with marked volume overload from congestive heart failure. Ultrafiltration is a process to remove fluid (excess salt and water) from the blood by using pressure differentials during treatment with a dialysis machine or similar filtration device. Peripheral or central venous access catheters may be used to access the patient's blood.

Proponents of this technique suggest that it may offer the potential for greater and more expeditious volume and sodium removal compared with conventional therapies. Ultrafiltration is generally used for those with decompensated heart failure whose fluid overload is unresponsive to medical management. This technique is also referred to as aquapheresis therapy. Work is also beginning on newer devices which could allow for continuous ultrafiltration in ambulatory patients.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

National Blue Cross Blue Shield Medical Policy Bulletin, 2.02.22, Ultrafiltration in Decompensated Heart Failure

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