K0606, Automatic external defibrillator, with integrated electrocardiogram analysis,
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Documentation Required
- A completed Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for the item; absence of a completed SWO will result in claim denial.
- For DMEPOS base items requiring Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD before item delivery; WOPD must list the base item and may list separately billed associated options, accessories, and supplies.
- Suppliers are required to maintain proof of delivery (POD) documentation and make POD available to the Medicare contractor upon request.
- Treating practitioner providing the order is expected to be experienced in the management of beneficiaries at risk for sudden cardiac death.
Key Coverage Criteria
- Automatic external defibrillators (wearable K0606 or nonwearable E0617) are covered for beneficiaries at high risk for sudden cardiac death (SCD) when they meet one of the specific clinical criteria below.
- Wearable defibrillator (K0606) covered for beneficiaries with a documented episode of ventricular fibrillation or a sustained ventricular tachyarrhythmia lasting ≥30 seconds that is not due to a transient or reversible cause and does not occur during the first 48 hours of an acute myocardial infarction.
- Wearable defibrillator (K0606) covered for beneficiaries with familial or inherited conditions conferring high risk of life‑threatening ventricular tachyarrhythmias (e.g., long QT syndrome or hypertrophic cardiomyopathy).
- Wearable defibrillator (K0606) covered for beneficiaries with documented prior myocardial infarction or dilated cardiomyopathy and measured left ventricular ejection fraction (LVEF) ≤ 0.35.
- Wearable defibrillator (K0606) covered when a previously implanted defibrillator requires explantation.
- Nonwearable automatic defibrillator (E0617) covered for beneficiaries with documented cardiac arrest due to ventricular fibrillation not caused by a transient or reversible condition.
4 Active Policies
CIGNA-0431, Cardioverter-Defibrillator Devices
L33690, Automatic External Defibrillators
AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines
CARELON-wearable-cardioverter-defibrillators-2024-07-01, Wearable Cardioverter Defibrillators
Related Codes
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