C1786, Pacemaker, single chamber, rate-responsive (implantable)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Full documentation requirements (if any) should be obtained from the referenced ACC/AHA 2025 AUC document or the applicable payer/contractor coverage policy.
- No documentation requirements explicitly stated in the provided excerpt.
- No specific documentation requirements are stated in this document chunk; providers must follow the documentation requirements specified in the applicable MAC LCD/NCD/LCA.
- Please refer to the CMS website (Medicare Coverage Database and Online Manual System (IOMs) and Transmittals) for the most current documentation and record-keeping requirements.
Key Coverage Criteria
- No covered indications explicitly stated in the provided excerpt.
- Refer to CMS Medicare Coverage Database for the most current applicable CMS National Coverage Determination (NCD)/Local Coverage Determination (LCD)/Local Coverage Article (LCA).
- 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.
- Permanent cardiac pacemakers for treatment of bradycardia arising from sinus node dysfunction.
- Permanent cardiac pacemakers for treatment of bradycardia arising from atrioventricular (AV) block.
- Clinical indications for Cardiac Electrophysiological Studies and Cardiac Catheter Ablation: coverage is determined by the applicable MAC LCD/NCD (no specific clinical indications listed in this document; see the referenced MAC LCD/NCD for covered diagnoses and scenarios).
2 Active Policies
HUMANA-CARDIAC-PACEMAKERS-MA, Cardiac Pacemakers
CARELON-permanent-implantable-pacemakers-2024-10-20, Permanent Implantable Pacemakers
Related Codes
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