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 Cardiac Defibrillators

CMS Publication 100-3, Manual, §20.4

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Electronic Analysis and Frequency Guidelines Including Transtelephonic Monitoring and Remote Follow-up

Pacemakers

Medicare National Coverage Determinations Manual (PDF, 582 KB)
See 20.8 – Cardiac Pacemakers (pages 28–370).

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.

2012 Transthoracic Echocardiography Coverage, Coding, and Reimbursement Overview

2012 Transthoracic Echocardiography Coverage, Coding, and Reimbursement Overview (PDF, 240 KB)
This brochure includes CPT coding information for 2012 Transthoracic Echocardiography Coverage, Coding, and Reimbursement. 4 pages.

Guideline II Pacing Systems

Medtronic Cardiac Rhythm Disease Management – Guideline II Pacing Systems / 2011 (PDF, 25 KB)
This document lists Medtronic pacemaker pulse generators and leads that fall under the Medicare Guideline II coverage policy. 3 pages.

Reimbursement Guide for ICD Implants

Reimbursement Guide for ICD Implants (PDF, 320 KB)
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. 24 pages.

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Private Payer Coverage Resources

Non-Medicare payers typically determine coverage for procedures based on prior authorization. With ICD patients, unless you are aware of the payer’s coverage policy for a specific patient population, we recommend that you contact the payer to seek prior authorization. If you ask about coverage after implant, it may result in unpaid claims, leaving both the hospital and the physician without compensation. Be sure to allow sufficient time to obtain prior authorization.

For more information related to private payers, visit the American Health Insurance Plans website.

CMS Fiscal Intermediary – Carrier Directory

To determine the applicable contractor for your state, access Medicare's Contacts Database at Medicare Directory.

Medicare A/B MAC information is available at :

Fiscal Intermediary/MAC Directory (PDF, 307 KB)

Carrier/MAC (PDF, 317 KB)

MAC Directory