Billing and Coding: Implantable Automatic Defibrillators

Medicare nationally covers implantable cardioverter‑defibrillators (ICDs) for (1) patients with prior sustained VT or cardiac arrest due to VF not caused by acute MI or transient/reversible causes; (2) patients with prior MI and LVEF ≤30%; (3) patients with severe ischemic or non‑ischemic dilated cardiomyopathy with NYHA II–III and LVEF ≤35% (non‑ischemic patients must have ≥3 months of optimal medical therapy); and (4) certain high‑risk familial/genetic arrhythmia syndromes. Additional requirements for covered indications include documented LVEF by approved modalities, clinical stability, absence of certain comorbid exclusions (eg, irreversible brain damage or non‑cardiac disease with <1 year survival), and for several indications a documented shared decision‑making encounter using an evidence‑based decision tool; replacements are allowed when clinically indicated.

"Personal history of sustained ventricular tachycardia (spontaneous or EP-induced) not associated with an acute myocardial infarction and not due to a transient or reversible cause is an indication ..."