Cardiac Implantable Devices (CID) Guidelines

This policy covers coverage criteria for cardiac implantable devices—including permanent and leadless pacemakers, implantable cardioverter‑defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices. It applies to patients with bradyarrhythmias, high‑risk ventricular arrhythmias (e.g., incessant VT), and selected heart failure populations defined by NYHA class (including ambulatory class IV on guideline‑directed medical therapy), and it requires meeting device‑specific definite/ reasonable indication criteria and numeric thresholds (e.g., HCM wall thickness ≥15 mm, QTc/NSVT definitions); atypical presentations require physician review and several explicit non‑indications and exclusions apply (e.g., no acute coronary syndrome, no inotropes for ambulatory class IV CHF).

"Reasonable Indications for ICD Implantation (CRID-3)"

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