C1824, Generator, cardiac contractility modulation (implantable)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Use of the most appropriate CPT/HCPCS codes for the service as of the date of service; claims must be accompanied by the covered code(s) to be considered for reimbursement.
- Clinical documentation that would be relevant when evaluating these technologies (as implied in the policy background and device indications) and that should be available in the medical record if coverage is being considered or appealed: - NYHA functional class documentation (I–IV) recorded by clinician. - Left ventricular ejection fraction (LVEF) with date and imaging modality (e.g., echocardiogram) and value (percent). - Natriuretic peptide levels (BNP or NT-proBNP) with dates and values (policy cites NT-proBNP thresholds used in trials, e.g., <1600 pg/mL vs >1600 pg/mL). - History of heart failure hospitalization(s) (dates, setting) within the prior 12 months, or documentation of elevated natriuretic peptides if no recent hospitalization. - Documentation of guideline-directed medical therapy (GDMT) status and duration (stable on GDMT and for how long — e.g., 30 days, 3 months, etc., as referenced for device trials and device labeling). - Documentation regarding CRT candidacy/status (e.g., whether patient is indicated for cardiac resynchronization therapy), when relevant. - For carotid sinus baroreflex activation: pre-implant carotid imaging (ultrasound or angiography) documenting carotid bifurcation location, percent atherosclerosis, presence/absence of ulcerative plaques. - Allergy history relevant to device materials (e.g., silicone, titanium) for BAROSTIM. - For pulmonary artery and other implantable pressure sensors: documentation of right heart catheterization data when performed (used for implantation/calibration in trials), and any device calibration records. - For devices with anticoagulation requirements (e.g., Cordella): documentation of ability to take dual antiplatelet therapy or anticoagulation for the required post-implant period (e.g., 1 month). - For inferior vena cava sensor (Norm/FIRE1) early studies: CT or imaging that documents IVC dimensions if used to correlate sensor measurements, and documentation of prior HF decompensation events per trial inclusion criteria. - Any procedural notes, device implantation reports, and records of device- or procedure-related complications should be available.
Key Coverage Criteria
- No covered indications. The following device implantations and monitoring procedures are considered experimental, investigational or unproven and are NOT covered under this policy: carotid sinus baroreflex activation device (e.g., BAROSTIM NEO) (CPT 0266T, 0268T; HCPCS C1825), left atrial pressure sensor implantation and monitoring (CPT 0933T), pulmonary artery pressure sensor implantation and monitoring (CPT 33289; HCPCS C2624, G0555), cardiac contractility modulation therapy (OPTIMIZER Smart S [...]
- Use of diagnostic tests (blood tests, electrocardiogram, chest x‑ray, stress test, echocardiogram) to aid in diagnosing heart failure.
- Echocardiogram (ECG/echo) to evaluate cardiac structure and function and to measure ejection fraction (EF); EF >50% is normal, EF <40% is consistent with systolic heart failure; heart failure may also occur with normal EF due to diastolic dysfunction (stiff myocardium).
- Medical treatment of heart failure to stop or delay disease progression, manage symptoms, prevent organ damage, reduce hospitalizations, and prolong life.
- Use of guideline-directed pharmacologic therapy for heart failure including angiotensin receptor neprilysin inhibitors (ARNI), ACE inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, diuretics, aldosterone antagonists, inotropes, and digoxin as clinically indicated.
- Surgical interventions for heart failure when clinically indicated, including coronary artery bypass grafting (CABG), heart valve repair or replacement, and heart transplantation.
8 Active Policies
CIGNA-0574, Cardiac Omnibus Codes
ANTHEM-SURG.00153, SURG.00153 Cardiac Contractility Modulation Therapy
MED202.068, Cardiac Contractility Modulation (CCM) Device
BCBSIL-MED202.068, Cardiac Contractility Modulation Device
BCBSMT-MED202.068, Cardiac Contractility Modulation Device
Related Codes
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