Cardiac Implantable Devices (CID) Guidelines

eviCore covers implantation, replacement, and upgrades of pacemakers (including leadless), ICDs, and CRT devices only for the numerous specified evidence‑based indications (eg, symptomatic sinus node dysfunction, clinically significant AV block, documented asystolic pauses, CRT/ICD primary and secondary prevention criteria) and excludes many non‑indications (eg, asymptomatic SND or first‑degree AV block, prophylactic pacing before TAVR without indication, ICD within 40 days post‑MI or 90 days post‑revascularization, NYHA IV without exceptions, VT/VF from reversible causes, etc.). Key requirements: contemporaneous, specific documentation is mandatory — history, symptom‑rhythm correlation, ECG/EPS data, LVEF and ≥3 months of optimal medical therapy for ICD primary prevention when required, device interrogation for replacements, and exclusion/correction of reversible causes (with EPS data when cited); replacement/similar‑device requests must also demonstrate guideline criteria are met.