Coding, Coverage, and Reimbursement Resources
Cardiac Rhythm and Heart Failure
Medical book and stethoscope 


Medicare Coverage

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

Jump to:


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

Medicare National Coverage Determination (NCD)

Medicare has National Coverage Determinations for Single and Dual Chamber Pacemakers and Implantable Cardiac Defibrillators. The following resources relate to Medicare Coverage for Cardiac Rhythm and Heart Failure (CRHF) products and procedures.

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

Cardiac Pacemaker

CMS Publication 100.03: Medicare Coverage Issues Manual, §20.8.3

The effective date of the National Coverage Determination (NCD) for Single and Dual Chamber Permanent Pacemakers is August 13, 2013. However, on January 27, 2016 the Medicare Learning Network (MLN) Matters® released Revised MM9078. This article includes the following key highlights:

  • To address claims processing issues, CMS has instructed MACs to implement this NCD at the local level until CMS revises the formal claims processing instructions.

Implantable Cardiac Defibrillators

CMS Publication 100-3, Manual, §20.4

Back to top


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


Medicare National Coverage Determinations Manual (PDF, 631 KB)
See 20.8.1 and – Cardiac Pacemakers (pages 20–22)

Implantable Cardioverter Defibrillators

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

Medicare has not issued national frequency guidelines for ICDs, check for local Medicare policies. The 2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities states every 3-6 months for ICD/CRT-D whether provided in person or remote, but more frequent evaluations may be required depending on the device characteristics and the patient’s clinical status.

Some local contractors have issued their own policies. Please contact your local contractor/payer for more information.

Back to top


New Medicare Centralized Investigational Device Exemption (IDE) Coverage Process

Medtronic prepared a brief summary of the changes associated with the New Medicare Centralized IDE Coverage Process. (PDF, 157 KB)

Back to top


Medtronic Resources for Cardiac Rhythm and Heart Failure (CRHF) Medicare Coverage Policies

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

Guideline II Pacing Systems

Medtronic Cardiac Rhythm and Heart Failure (CRHF) – Guideline II Pacing Systems (PDF, 119 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, 711 KB)
This guide has been developed to assist you in seeking coverage and payment for ICD and CRT-D therapies. It also provides hospital and physician coding information and some answers to frequently asked questions (FAQs).

Coding for a Patient Receiving an MRI Scan (PDF, 216 KB)
Hospital and physician coding for a Medicare patient receiving an MRI Scan

Back to top

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 Contractor information is available at:

Fiscal Intermediary/MAC (PDF, 163 KB)

Carrier/MAC (PDF, 163 KB)

Additional information is available at the Medicare Administrative Contractors page at

Last updated: 18 Feb 2016

Learn about ICD-10

Updated: October 7, 2015

ICD-9-CM to ICD-10-PCS Procedure Code Crosswalks for Inpatient Hospitals

(PDF, 96 KB)

Implantable Cardioverter-Defibrillators
(PDF, 111 KB)

Implantable Cardiac Event Recorders
(PDF, 55 KB)

Electrophysiology and Ablations
(PDF, 57 KB)

ICD-9-CM to ICD-10-CM Diagnosis Code Crosswalks

Updated ICD-9-CM to ICD-10 DX Code Crosswalks for CRHF Services
(PDF, 654 KB)

View Hospital slides
(PDF, 1.4 MB)

View Hospital ICD Diagnosis Code Crosswalks
(PDF, 25 KB)

icon-video View Hospital Presentation

View Physician slides
(PDF, 2.5 MB)

View Physician ICD Diagnosis Code Crosswalks
(PDF, 25 KB)

icon-video View Physician Presentation

Trouble viewing the video?

Download Windows Media Player 11

Join Our E-mail List

Subscribe to receive news and updates.

Reimbursement Hotline
(866) 877-4102