Nonwearable Automatic External Defibrillators

This policy covers nonwearable automatic external defibrillators (AEDs) for patients at high risk of life‑threatening ventricular arrhythmias — for example, documented VF or sustained VT not due to transient/reversible causes, inducible VT/VF on EP study, high‑risk inherited arrhythmia syndromes, ischemic or nonischemic cardiomyopathy with reduced LVEF (generally ≤35%), or when implantation is contraindicated or explantation is required. Coverage is limited to those who meet the policy’s specific clinical and timing requirements (e.g., post‑MI and EP study timing, EF measurement by angiography/radionuclide/echo) and excludes arrhythmias due to transient/reversible causes, acute MI‑associated VT/VF, recent CABG/PTCA or recent enzyme‑positive MI, cardiogenic shock, irreversible brain damage, noncardiac disease with life expectancy <1 year, and other listed limitations.

"Documented episode of cardiac arrest due to ventricular fibrillation not due to a transient or reversible cause."