Cardiac Implantable Devices (CID) Guidelines

This policy covers cardiac implantable devices (pacemakers, implantable cardioverter‑defibrillators, and cardiac resynchronization/left ventricular pacing systems) for the treatment and prevention of arrhythmias and heart failure. It addresses use in patients with symptomatic or high‑risk arrhythmias (e.g., incessant or recurrent VT, long QT syndrome, hypertrophic or non‑compaction cardiomyopathies) and across NYHA/ambulatory heart‑failure classes I–IV. Major requirements include imaging confirmation for HCM, QTc assessment (QTc >0.44 s generally abnormal), absence of active acute coronary syndrome and inotropes plus optimization on guideline‑directed medical therapy for advanced heart failure, and additional documentation/physician review for prior devices or atypical presentations.

"Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple leads | 33231"