Billing and Coding: Implantable Automatic Defibrillators
A56326
Medicare covers implantable cardioverter-defibrillators (ICDs) for six national indications including prior sustained VT/VF, post‑MI with LVEF ≤30%, severe ischemic or non‑ischemic dilated cardiomyopathy with specified LVEF and NYHA class II–III criteria, certain genetic arrhythmia syndromes, and device replacement for battery end‑of‑life or malfunction. Coverage requires documented LVEF measured by approved modalities, absence of exclusionary conditions (recent CABG/PCI or MI within specified windows, NYHA IV where noted, poor prognosis from non‑cardiac disease, uncontrolled supraventricular tachycardia), and—for several indications—a documented shared decision‑making encounter using an evidence‑based tool; local MACs determine bridge‑to‑transplant coverage and other non‑listed indications may be covered only under Category B IDE trials.
"Patients with a personal history of sustained ventricular tachyarrhythmia (sustained VT) or cardiac arrest due to ventricular fibrillation (VF) not associated with an acute myocardial infarction an..."