Does 33207 require prior authorization?

Yes, 33207 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 33207?

Medicare facility rate: $422.19. Non-facility rate: $422.19. Work RVU: 7.61.

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

7.61

Facility

$422.19

Non-Facility

$422.19

Claims for Group I and Group II diagnoses must be attested with modifier KX to confirm documentation is on file verifying symptomatic arrhythmia or high risk of progression requiring a permanent pacemaker.
Group II contractor‑allowed diagnoses must be accompanied by the applicable ICD‑10‑CM diagnosis code(s) on the claim and KX attestation; contractor determination may be required for coverage.
Group III conditions (not addressed by the NCD) should be attested with modifier SC when applicable and are subject to separate contractor review and coverage policies.
Only CPT codes for initial insertion of permanent pacemakers (33206, 33207, 33208) apply to this NCD; claims should use these CPTs for initial implant procedures and not replacement CPTs addressed elsewhere.

Implantation of a single‑chamber or dual‑chamber permanent cardiac pacemaker is covered for documented non‑reversible symptomatic bradycardia due to sinus node dysfunction.
Implantation of a single‑chamber or dual‑chamber permanent cardiac pacemaker is covered for documented non‑reversible symptomatic bradycardia due to second‑degree and/or third‑degree atrioventricular (AV) block.
Symptoms attributable to bradycardia (heart rate <60 bpm) such as syncope, seizures, congestive heart failure, dizziness, or confusion qualify as symptomatic bradycardia for coverage purposes.
Additional contractor‑allowed diagnoses (Group II) are covered when the practitioner attests (use modifier KX) that documentation is on file verifying symptomatic arrhythmia or high potential for progression; examples include symptomatic/selected bundle branch/fascicular blocks, certain supraventricular tachycardias when pacing controls SVT, atrial fibrillation/flutter with symptomatic bradycardia due to therapy, and hypersensitive carotid sinus syndrome with cardioinhibitory response.
Implantation of a single-chamber or dual-chamber permanent cardiac pacemaker is covered for documented non-reversible symptomatic bradycardia due to sinus node dysfunction.
Implantation of a single-chamber or dual-chamber permanent cardiac pacemaker is covered for documented non-reversible symptomatic bradycardia due to second-degree and/or third-degree atrioventricular (AV) block.

A54958 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker

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A54909 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers

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A54926 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers

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A54982 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers

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Ask Verity about documentation requirements, denial risks, or coverage in your state.