Billing and Coding: Implantable Automatic Defibrillators

Medicare covers implantable cardioverter-defibrillators (ICDs) for patients with prior sustained VT/VF arrest, for certain post‑MI and cardiomyopathy patients meeting LVEF and NYHA criteria, for high‑risk familial/genetic arrhythmia syndromes, and for replacement when devices reach ERI/battery end‑of‑life or malfunction. Coverage for several primary prevention populations (post‑MI with LVEF ≤30%, ischemic/non‑ischemic cardiomyopathy with LVEF ≤35%) requires specific timing exclusions (no recent MI or revascularization), documented LVEF by approved imaging modalities, and a pre‑implant shared decision‑making encounter using an evidence‑based tool; other billing, coding, and local‑MAC exceptions (e.g., bridge‑to‑transplant, Category B IDE) apply.

"Patients with a personal history of sustained ventricular tachyarrhythmia (sustained VT) or cardiac arrest due to ventricular fibrillation (VF) not associated with an acute MI and not due to a tran..."