Billing and Coding: Implantable Automatic Defibrillators

Medicare covers implantable cardioverter defibrillators (ICDs) for secondary prevention (prior sustained VT or cardiac arrest from VF) and for specified primary-prevention populations with reduced LVEF and defined heart failure classes, subject to timing exclusions after recent MI or revascularization and other clinical stability criteria. Several primary-prevention categories (prior MI with LVEF ≤30%; ischemic or non-ischemic dilated cardiomyopathy with LVEF ≤35% and NYHA II–III; high-risk genetic/familial disorders) require documentation of LVEF by approved modalities and a formal shared decision-making encounter using an evidence-based tool; replacements are covered for battery end/ERI or device/lead malfunction. Coding, billing, and place-of-service restrictions apply as specified and other non-listed indications may only be covered under Category B IDE trials with proper modifiers.

"ICD implantation is covered for patients with a personal history of sustained ventricular tachyarrhythmia (sustained VT) or cardiac arrest due to ventricular fibrillation (VF) that is not associate..."