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

Medicare covers implantation of single- and dual-chamber permanent cardiac pacemakers for documented non-reversible symptomatic bradycardia due to sinus node dysfunction and second- or third-degree AV block, with specific contractor-allowed indications (Group II) and objective-threshold exceptions allowed with attestation (Modifier -KX). Non-covered scenarios include reversible causes of bradycardia, multiple asymptomatic conduction abnormalities (unless meeting specified exceptions), devices/therapies outside single- or dual-chamber pacemakers (Group III; attest with Modifier -SC), and generator replacements which are not addressed by this NCD. Claims must use the initial insertion CPT codes 33206–33208, appropriate ICD-10-CM diagnosis codes from the policy lists, and maintain supporting diagnostic documentation and attestation in the medical record.

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