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

Medicare covers implantation of single- and dual-chamber permanent cardiac pacemakers for documented non-reversible symptomatic bradycardia due to sinus node dysfunction or second-/third-degree AV block; selected additional symptomatic conduction disorders may be covered by contractors (Group II) with attestation. Coverage requires appropriate documentation and use of modifier -KX for Group I/II diagnoses (or -SC when records do not support a covered diagnosis); the NCD applies to initial insertion CPT codes 33206–33208 and does not address generator replacements or multi-chamber/CRT devices.

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

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