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

Medicare national coverage permits 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 symptomatic bradycardia generally defined by HR <60 bpm and attributable symptoms (eg, syncope, dizziness, CHF). Practitioners must attest with modifier -KX that documentation is on file (ECG/monitoring/EP study results, exclusion of reversible causes, and clinical notes); selected asymptomatic patients meeting objective monitoring or electrophysiologic criteria or contractor‑approved Group 2 diagnoses may be covered with KX attestation. This guideline applies to initial insertion CPT codes 33206–33208 and does not address generator replacements, biventricular or multi‑chamber (>2) devices, CRT, or certain arrhythmia devices.

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