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

Medicare nationally covers implantation of single- and dual-chamber permanent cardiac pacemakers for documented non-reversible symptomatic bradycardia due to sinus node dysfunction and for symptomatic second- or third-degree AV block. Additional contractor-allowed symptomatic conduction disorders and select tachyarrhythmia indications may be covered when attested with modifier -KX and supported by documentation; reversible causes, asymptomatic conduction abnormalities, brief/intermittent pacing needs, and indications not addressed by the NCD are not covered under this determination and may require local MAC review.

"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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