NCA - Implantable Cardioverter Defibrillators (CAG-00157R4)

Implantable cardioverter defibrillators (ICDs) are covered for patients aged 18 and older when deemed medically necessary by a licensed physician, specifically for primary and secondary prevention of sudden cardiac death in individuals with structural heart disease or those at high risk for ventricular arrhythmias. Key requirements for coverage include a prior history of cardiac arrest or lethal arrhythmia, and services must be authorized in advance. Limitations include exclusion of elective procedures and mandates for comprehensive clinical documentation to support medical necessity.

"Surgical procedures covered when deemed medically necessary by a licensed physician."

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