Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker

CMS NCD 20.8.3 covers implantation of single‑ or dual‑chamber permanent cardiac pacemakers for documented non‑reversible symptomatic bradycardia due to sinus node dysfunction or second/third‑degree AV block, with symptoms generally defined by heart rate <60 bpm (e.g., syncope, dizziness, CHF). Contractor‑allowed additional diagnoses may be covered if the provider attests with modifier KX and documentation is on file; several asymptomatic or reversible conditions and devices (e.g., biventricular/CRT, generator replacements) are not covered under this NCD and are subject to separate contractor review.

"Implantation of a single‑chamber or dual‑chamber permanent cardiac pacemaker is covered for documented non‑reversible symptomatic bradycardia due to sinus node dysfunction."

Sign up to see full coverage criteria, indications, and limitations.