The Centers for Medicare & Medicaid Services (CMS) has issued its updated National Coverage Determination (NCD) for transcatheter aortic valve replacement (TAVR), concluding a nine-month review process that included extensive engagement from The Society of Thoracic Surgeons (STS) and partner organizations representing the multidisciplinary heart team, including the American College of Cardiology (ACC), the Society for Cardiovascular Angiography & Interventions (SCAI), and the American Association for Thoracic Surgery (AATS).
The final NCD follows CMS' June 15, 2026, proposed decision to update the existing TAVR coverage policy. Throughout the review, STS provided extensive feedback and advocated for policies that preserve the multidisciplinary heart team model, maintain appropriate cardiac surgeon involvement in TAVR evaluation and care, and support continued evidence development as TAVR expands into additional patient populations and indications. View a comparison chart of the existing NCD, proposed changes, and final policy.
STS Advocacy Throughout the Process
STS was actively engaged throughout the NCD review, working both independently and as part of a multi-society coalition. The Society submitted formal comments, met with CMS officials involved in developing the policy, engaged CMS leadership, and participated in discussions with the NCD requester Edwards Lifesciences and other professional societies regarding areas of potential consensus.
Throughout the process, STS consistently advocated for three priorities:
Preserving the multidisciplinary heart team model as an essential component of TAVR decision-making.
Maintaining cardiac surgeon involvement in patient evaluation, treatment decisions, and TAVR care.
Continuing evidence development in areas where important clinical questions remain unanswered.
STS also advocated for expanded evidence development requirements as TAVR moves into newer indications and lower-risk patient populations, including severe bicuspid aortic stenosis, moderate aortic stenosis, pure aortic regurgitation, valve-in-valve procedures, and patients at low surgical risk.
From the Existing Policy to the Final NCD
The original TAVR NCD, established in 2012, helped guide the measured adoption of TAVR in the United States by establishing coverage requirements that included participation by a multidisciplinary heart team and the availability of on-site cardiac surgical services.
CMS reopened the NCD in December 2025 following a request from Edwards Lifesciences. During the subsequent review, STS worked to ensure that an updated policy would recognize advances in TAVR while maintaining safeguards that support patient safety, multidisciplinary decision-making, and evidence-based care.
CMS released its final NCD on September 10, 2026. The NCD maintains requirements for hospitals to have on-site cardiac surgery capabilities and access to critical care resources and continues to recognize the multidisciplinary heart team. CMS removed coverage with evidence development (CED) status for severe symptomatic aortic stenosis (AS). It has approved TAVR for asymptomatic severe aortic stenosis but under the provision of CED.
CMS defined the heart team as at least one cardiologist and one surgeon, but also included advanced practice providers, nurses, and other members. While the suitability for surgical aortic valve replacement must be evaluated, the only mandated in-person visit is the TAVR operator. They state that another evaluation by an additional heart team TAVR operator is not required but is covered if performed. A single TAVR operator is acceptable, and it may be a cardiologist or surgeon. If determined appropriate by the heart team, a second operator would be supported and it may be a cardiologist or a surgeon.
What the Final NCD Means
The final policy maintains several important elements of the existing TAVR coverage framework, including:
Continued requirements for hospitals to have on-site cardiac surgery capabilities.
Continued access to critical care resources.
Recognition of the multidisciplinary heart team.
Coverage with evidence development for asymptomatic aortic stenosis.
Looking Ahead
STS will continue to monitor implementation of the final NCD and advocate for evidence-based TAVR care, patient safety, outcomes, and policies that support multidisciplinary decision-making, appropriate surgical expertise, and rigorous evidence development.
Summary: The final NCD maintains key elements of the existing TAVR coverage framework, including hospital requirements for on-site cardiac surgery capabilities and critical care resources, continued recognition of the multidisciplinary heart team, and CED for asymptomatic aortic stenosis. While the policy does not incorporate all of STS' recommendations regarding cardiac surgeon involvement and expanded evidence development, STS will continue working to ensure that patient safety, multidisciplinary care, and high-quality clinical evidence remain central to TAVR treatment and coverage decisions.
Our work does not end with the CMS announcement. This is an opportunity for every surgeon involved in valve therapies to stay actively engaged in your heart team, make every effort to evaluate all patients being considered for TAVR or SAVR, and apply all available evidence to provide informed decisions that protect patients. STS will continue to advocate for evidence-based policies that support multidisciplinary care, appropriate surgical expertise and the highest-quality care for patients with structural heart disease.
For Sean Jordan, MD, the need was clear: Too many patients across East Tennessee faced significant barriers to lung cancer screening—not because they lacked the need for screening, but because they lacked access to it.
East Tennessee has some of the highest smoking and lung cancer rates in the country, while screening rates remain below national averages. For patients in rural Appalachian communities, mountain roads, long travel distances, limited specialty care, and a lack of CT scanners in many counties can make screening especially difficult.
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Dr. Jordan is the co-director of thoracic oncology at UTMC.
Jordan, chief of thoracic surgery and director of lung cancer screening at the University of Tennessee Medical Center (UTMC), saw an opportunity to bring screening directly to the communities that needed it most.
The result is a 45-foot mobile CT lung cancer screening unit designed to serve patients across 21 counties in East Tennessee.
“We needed something that could navigate our geography and be convenient and inviting for patients,” Jordan said.
Making the Mobile Unit a Reality
Bringing the vision to reality required more than clinical expertise. It required funding, collaboration, persistence, and advocacy.
The University of Tennessee Medical Center already had a robust lung cancer screening program, but funding a mobile program presented a significant challenge. Working with Congressman Tim Burchett, the team secured $2.3 million through the U.S. Department of Agriculture to fund the mobile unit and supporting software.
The team then pursued a competitive Rural Health Resiliency grant through the Tennessee Department of Health to support program personnel. STS Advocacy strengthened the application by providing a letter of support from then-STS President Dr. Jenna Romano.
The effort ultimately resulted in a $5.45 million grant—one of the largest awarded in the state—to support personnel for the mobile lung cancer screening program and a mobile mammography program.
Jordan also credits Rob Headrick, MD, chief of thoracic surgery at CommonSpirit-Memorial Hospital-Rees Skillern Cancer Institute-Chattanooga and chair of the STS Workforce on Health Policy, Reform, and Advocacy, with providing guidance and connecting the team with STS Advocacy resources.
Bringing Screening to Patients
The mobile unit will bring CT screening and a multidisciplinary team—including technologists, nurses, patient liaisons, and behavioral health professionals—directly into underserved communities.
“Many patients are not willing to travel outside their communities to seek even basic care,” Jordan said. “We can bring our medical expertise and the CT scanner itself directly to their communities.”
The program will also provide tobacco cessation services, education, and centralized coordination to help patients who need additional care move through the health care system more quickly.
Ultimately, success will be measured by whether more cases of lung cancer are detected at an earlier, more treatable stage.
A medical oncologist once told him that fewer patients seemed to be arriving with stage II and III lung cancer. “That to me is the biggest win I can think of for this community,” Jordan said. “We are shifting the stage of lung cancer earlier to when it is most survivable.”
Leading Through Advocacy
The project took two years to move from funding to implementation, but Jordan hopes its impact extends beyond East Tennessee.
“Reaching out to other mobile lung programs and STS Advocacy can introduce you to a community of like-minded groups” who can share their experiences and help develop programs that work for individual communities, he said.
The experience reinforced Jordan's belief that thoracic surgeons should play a leading role in strengthening screening programs nationwide.
“Apart from patients and families, no one in the hospital sees the benefits of a robust lung cancer screening program as much as thoracic surgeons,” he said. “We should be leaders and advocates for strengthening our own programs and all programs nationwide.”
Over the past 25 years, Medicare physician reimbursement has fallen by approximately 33% after adjusting for inflation, even as the cost of delivering care has continued to rise. This widening gap threatens patient access to care, places increasing financial pressure on physician practices, and undermines the long-term sustainability of the physician workforce.
“The Society of Thoracic Surgeons applauds the House bipartisan Doctors Caucuses for their leadership in developing the Patients First Act,” said STS President Vinay Badhwar, MD. “STS has worked closely with members of the caucuses throughout this process, and we are encouraged to see several longstanding physician priorities reflected in the legislation.
In particular, we appreciate the inclusion of meaningful reforms to Medicare's budget neutrality policies and provisions based on the Access to Claims Data Act—legislation developed with strong input from STS to improve physicians' access to timely, comprehensive Medicare claims data.
These policies represent important steps toward a more stable and transparent Medicare payment system that better supports physicians and the delivery of high-quality patient care. We look forward to continuing to work with Congress to advance these reforms and strengthen the Medicare program for both patients and physicians."
This afternoon, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) proposed rule. STS has put together a summary of key provisions affecting cardiothoracic surgery in the rule.
Physician Payment
As required by statute starting in CY 2026, there are two separate conversion factors (CFs): one for physicians and practitioners participating in qualifying alternative payment models (or QPs) and one for those who are not (non-QPs). For CY 2027, CMS has proposed a conversion factor (CF) of $32.84 for non-QPs and $33.16 for QPs.
While this is the second year in a row we are seeing base CF updates, as required by statute, the conversion factor for physicians will actually decrease due to the expiration of the temporary 2.5 percent increase for CY 2026, even though the formula incorporates positive base updates.
Additionally, other policies continue to diminish hospital-based proceduralists’ reimbursement. Policies such as the efficiency adjustment and reductions to practice expenses continue to threaten surgeons’ ability to practice. Reimbursement also continues to lag inflation. STS is working with the broader physician community and members of the Republican and Democratic Doctors Caucuses to reform physician reimbursement.
Surgical Global Codes
CMS continues to question the valuation of 10- and 90-day global surgical codes. While it does not make any proposal to conduct an across-the-board revaluation at this time, CMS states that it is interested in how “CMS could 'right-size' payments for the globals over time to ensure they remain aligned with current clinical practice and resource costs, are more readily updated based on empirical data, and do not obscure differences in cost and value across settings of care.” STS has consistently pushed back against efforts to reduce payments in surgical global periods, advocating for accurate valuation of surgical services and policies that reflect the complexity, intensity, and longitudinal care provided by cardiothoracic surgeons.
Quality Payment Program (QPP)
CMS is proposing to sunset the traditional Merit-based Incentive Payment System (MIPS) reporting option in 2029 and is pushing forward with its efforts to transition all MIPS participants towards MIPS Value Pathways (MVPs), which will be reported by subspecialty.
Inpatient Only (IPO) List in Hospital Outpatient Rule
CMS also recently released the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) rule. Hospitals that meet their outpatient quality reporting requirements will receive a 2027 payment increase of 2.4%.
Additionally, CMS has long maintained an Inpatient Only (IPO) list identifying services that are not payable under the OPPS because they must be performed on an inpatient basis. In last year's rulemaking, CMS finalized the elimination of the IPO list over three years, suggesting it gives physicians greater flexibility in determining the most clinically appropriate site of care.
As codes are removed from the IPO list, CMS is pricing them for reimbursement in the hospital outpatient and Ambulatory Surgical Center (ASC) settings. Removal from the list does not mean that the procedures cannot be performed in the hospital inpatient setting, only that, if safe for the patient, they may now be performed in and paid for in the outpatient or ASC setting.
CY 2027 marks the second year of this transition. Of particular interest to STS members, CMS is proposing to remove services from the respiratory, mediastinum, diaphragm, digestive, lymphatic, and endocrine clinical families, which include virtually all of the general thoracic procedures. Removal from the IPO list does not require that surgeries for Medicare patients be performed in the outpatient setting.
However, STS continues to have significant concerns that removal of CT surgery from the IPO list could impact patient safety and result in other insurers dictating where surgeries are performed without proper safeguards or clinical input.
Earlier this month, the House Committee on Appropriations marked up its fiscal year (FY) 2027 appropriations bill for the Department of Health and Human Services (HHS). The House bill would provide $110.8 billion in discretionary funding for HHS, a reduction of $4 billion.
On May 6, 2026, Representative Eric Burlison (R-MO) visited SSM Health Saint Louis University Hospital to learn how policy decisions impact surgeons—and the patients they serve. When lawmakers visit a hospital, advocacy becomes tangible. That was the case when Rep. Burlison toured SSM Health Saint Louis University Hospital alongside cardiothoracic surgeons Dr. Jen Vigneswaran, Dr.
Fifty STS delegates gathered in Washington DC, March 23-24, to help influence healthcare policy and champion causes important to CT surgeons and their patients. Learn how you can get involved with STS advocacy.
As a surgical resident, I am trained to focus on what is immediately in front of me, the patient, the operation, the outcome. But stepping into a congressional office as part of STS's advocacy efforts offered a stark reminder: many of the factors that shape our patients’ outcomes are determined far beyond the walls of the operating room.
Susan Moffatt-Bruce, MD, PhD, MBA, Chair, STS Council on Health Policy and Relationships, shares how STS advocacy delivers real impact for members and patients alike – and how you can get involved. Elliot Servais, MD, discusses mobile lung cancer screening and how STS is influencing key policy decisions.
Last week, the Centers for Medicare & Medicaid Services (CMS) published the Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) proposed rule. STS has compiled a summary of the rule’s key provisions affecting cardiothoracic surgery.
On Jan. 1, 2026, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment policy, through the Medicare Physician Fee Schedule (MPFS), that directly impacts cardiothoracic surgery. The “efficiency adjustment,” reduces non-time-based work Relative Value Units (wRVUs) by 2.5%, with additional cuts scheduled every three years.
