93642
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
4.51
Facility
$330.00
Non-Facility
$330.00
Documentation Required
- Refer to CMS website for the most current applicable CMS Online Manual System (IOMs) and Transmittals.
- Providers should follow the documentation requirements specified in the applicable MAC LCD for the service/request (this document directs reliance on the MAC LCD but does not list specific documentation).
- No explicit documentation requirements are provided in the excerpt.
- Documentation requirements are referenced indirectly: see Pub. 100-08, Medicare Program Integrity Manual, Chapter 3 §3.3 for policies/guidelines applied during review and NCD 20.4 (ICDs) for any NCD-specific documentation requirements; clinical records, device implantation reports, and indication-specific documentation would be expected per those referenced policies.
Key Coverage Criteria
- No explicit covered indications, diagnoses, or clinical scenarios are stated in the provided document text. (The excerpt contains only header, metadata, and table of contents.)
- Humana and subsidiaries apply a Medicare Administrative Contractor's (MAC's) LCD to all requests (both Part A and Part B services) within the MAC's applicable geographic jurisdiction.
- Refer to CMS Medicare Coverage Database for the most current applicable CMS National Coverage Determination (NCD)/Local Coverage Determination (LCD)/Local Coverage Article (LCA).
- Reference to NCD 20.4: Implantable Cardioverter Defibrillators (ICDs) — implies coverage/criteria for ICD implantation per NCD 20.4.
- EV-ICD is reported to treat ventricular tachyarrhythmias while avoiding certain risks of transvenous ICDs because the lead is placed under the sternum outside the heart.
- Reference to NCA CAG-00469N: Cardiac Contractility Modulation (CCM) for Heart Failure — implies this device/therapy is the subject of a national coverage analysis.
2 Active Policies
CARELON-electrophysiological-studies-2024-07-01 — Electrophysiological Studies
HUMANA-CARDIOVERTER-DEFIBRILLATORSCARDIAC-RESYNCHRONIZATION-THERAPY-MA — Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage
Related Codes
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