Billing and Coding: Cardiac Resynchronization Therapy (CRT)

Coverage for Cardiac Resynchronization Therapy (CRT) requires meeting the related LCD L39080 and CMS reasonable-and-necessary criteria, including documented reduced left ventricular ejection fraction, prolonged QRS duration and specified QRS morphology, NYHA functional class, and appropriate need for ventricular pacing. The patient should be on a stable heart-failure medication regimen unless contraindicated, the implanted device must be FDA-approved for CRT, and the medical record must contain specific documentation elements (EF measurement, QRS duration/morphology, operative report, medication regimen, clinician signature); upgrades from existing pacemakers/ICDs require individualized risk-benefit documentation.

"Patient has reduced left ventricular ejection fraction (most recent EF documented) meeting the related LCD L39080 reasonable-and-necessary criteria for CRT."