Cardiac Rhythm and Heart Failure
Search the Medicare coverage database when looking for local or national coverage information.
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.
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:
Medicare National Coverage Determinations Manual (PDF, 631 KB)
See 20.8.1 and 126.96.36.199 – Cardiac Pacemakers (pages 20–22)
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.
Medtronic prepared a brief summary of the changes associated with the New Medicare Centralized IDE Coverage Process. (PDF, 157 KB)
Medtronic has published several resources to help you understand the coverage policies for CRHF products.
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 (PDF, 887 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). 24 Pages.
Coding for a Patient Receiving an MRI Scan (PDF, 216 KB)
Hospital and physician coding for a Medicare patient receiving an MRI Scan
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, 155 KB)
Carrier/MAC (PDF, 156 KB)
Additional information is available at the Medicare Administrative Contractors page at CMS.gov.