33208
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
8.31
Facility
$455.92
Non-Facility
$455.92
Documentation Required
- 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.
Key Coverage Criteria
- 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.
15 Active Policies
A54958 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker
J05
A54909 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
J06
A54926 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
J09
A54982 — Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
J12
Related Codes
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