0796T — Tcat ins 2chmbr ldls pm ra
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Professional claims must include ICD-10 diagnosis code Z00.6, modifier Q0, and the 8-digit clinical trial identifier placed in item 19 preceded by 'CT' on paper claims (or in the 837 P-loop 2300 REF02/REF01 = P4 electronic field).
- Institutional (outpatient facility) claims must include ICD-10 diagnosis code Z00.6, modifier Q0 (outpatient facility claims only), Condition Code 30, and Value Code D4 with the 8-digit clinical trial identifier.
- The 8-digit clinical trial identifier submitted must match an identifier on the CMS list of approved CED leadless pacemaker studies (see Leadless Pacemakers | CMS).
- Claims lacking the specified billing elements are subject to rejection as unprocessible or denial, and providers should confirm the correct use of 'CT' on paper claims and P4 coding on electronic claims.
Key Coverage Criteria
- Leadless pacemaker procedures (initial placement or replacement) are covered only when performed in CMS-approved Coverage with Evidence Development (CED) clinical studies per NCD 20.8.4 effective January 18, 2017.
- Coverage under this NCD applies to both Medicare Part A and Part B claims when the CED conditions are met.
- Any covered item/service must also meet Medicare Reasonable and Necessary requirements (Social Security Act §1862(a)(1)(A) and Medicare Program Integrity Manual Chapter 3, §3.6.2.2).
2 Active Policies
A59819 — Billing and Coding: Leadless Pacemakers
REGENCE-SUR217 — Dual Chamber Leadless Cardiac Pacemakers
Related Codes
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