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

CMS covers implanted single- and dual-chamber permanent cardiac pacemakers for documented non-reversible symptomatic bradycardia due to sinus node dysfunction or second-/third-degree AV block and for certain contractor-allowed diagnoses when attested. Reversible causes of bradycardia, many asymptomatic conduction abnormalities, intermittent/brief pacing needs, biventricular or >2-chamber devices, and generator replacements are not covered under this NCD. Claims for covered and contractor-allowed indications require attestation with Modifier -KX and supporting diagnostic documentation; other unaddressed conditions require contractor review and attestation with Modifier -SC.

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

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