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

Medicare nationally covers 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 required attestation using Modifier -KX and supporting documentation. Contractor-allowed additional diagnoses and certain asymptomatic but high-risk findings (e.g., prolonged asystole, long pauses, exercise-induced AV block, specific EP findings) may also be covered with Modifier -KX; reversible causes, specified asymptomatic conduction abnormalities, intermittent brief pacing needs, pediatric/CRT/generator replacements and other items not addressed by the NCD are excluded and require local contractor review or Modifier -SC.

"Documented non-reversible symptomatic bradycardia due to sinus node dysfunction (symptoms attributable to heart rate <60 beats per minute) is covered; attest with Modifier -KX and maintain document..."