Coverage

Medicare Coverage

Search the Medicare coverage database when looking for local or national coverage information.

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• Medicare Coverage for Pacemakers, ICDs and CRT Devices
• Electronic Analysis and Frequency Guidelines
• Medtronic Resources for CRDM Coverage Policies

Medicare Coverage for Pacemakers, Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy Devices

Medicare National Coverage Determination (NCD)
Medicare has National Coverage Determinations for Pacemakers and Implantable Cardiac Defibrillators. The following resources relate to Medicare Coverage for Cardiac Rhythm Disease Management (CRDM) products and procedures.

Below are the links to the Medicare National Coverage Determinations for CRDM therapies.

Cardiac Pacemaker
CMS Publication 100.03: Medicare Coverage Issues Manual, §20.8.1

Implantable Cardioverter Defibrillator (ICD)
CMS Publication 100.03: Medicare Coverage Issues Manual, §20.4

Cardiac Resynchronization Therapy - Pacemaker (CRT-P)
At this time there is no National Coverage Determination for CRT-P. Check with your local contractor or fiscal intermediary (MAC) to determine the coverage policies for CRT-P therapies in your area.

Cardiac Resynchronization Therapy - Defibrillator (CRT-D)
At this time there is no National Coverage Determination for CRT-D. Check with your local contractor or fiscal intermediary (MAC) to determine the coverage policies for CRT-D therapies in your area.
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Electronic Analysis and Frequency Guidelines including Transtelephonic Monitoring and Remote Follow-up

Pacemakers

Medicare National Coverage Determinations Manual Note: See pp. 28–37

Implantable Cardioverter Defibrillators
Medicare has not issued national follow-up frequency guidelines for ICDs including transtelephonic monitoring and remote monitoring.

The ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices states that ICDs should be followed at 1-4 month intervals, depending on the device model and the patient's clinical status.

Some local contractors have issued their own policies. Please contact your local contractor/payer for more information.
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Medtronic Resources for Cardiac Rhythm Disease Management Medicare Coverage Policies

Medtronic has published several resources to help you understand the coverage policies for CRDM products.

Echocardiography for AV Optimization and V-V Timing This brochure includes CPT coding information for Echocardiography for AV Optimization and V-V Timing. 3 pages.	English
Guideline II Pacing Systems This document lists Medtronic pacemaker pulse generators and leads that fall under the Medicare Guideline II coverage policy. 3 pages.	English
ICD/CRT-D Coverage Reference Guide This guide provides a detailed decision tree to help you understand Medicare coverage for ICD and CRT-D devices. 2 pages.	English
Inpatient vs. Outpatient Patient Considerations for Defibrillator, Pacemaker, and Cardiac Resynchronization Therapy Implants This brochure assists in identifying key items to consider when determining whether a patient should be admitted to the hospital as an Inpatient or be considered an Outpatient for his/her device implant (pacemaker, defibrillator and CRT device). 16 pages.	English
Physician In-Office Electronic Analysis for Patients Implanted with Cardiac Devices Data for electronic analysis of implanted cardiac devices (pacemakers, ICDs and bi-ventricular pacemakers and ICDs) can be obtained by in-office interrogation of the device using a programmer, remote monitoring, or transtelephonic monitoring (TTM). This document provides brief summaries of the CPT codes applicable to in-office analysis of data obtained using these methods, and identifies Medicare frequency guidelines. 5 pages.	English
Reimbursement Guide for ICD Implants This guide has been developed to assist you in seeking coverage and payment for ICD and CRT-D therapies. This guide also incorporates information regarding the use of ICDs for patients with the expanded coverage indications reflected in the SCD-HeFT and MADIT-II studies. Updated coding information and answers to Frequently Asked Questions (FAQs) about coverage, coding and payment are also in this guide. 26 pages.	English

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