External Defibrillators - DME.CD.100.A

Wearable (K0606) and non‑wearable external defibrillators (E0617) are covered when medically necessary for patients at high risk for ventricular tachyarrhythmia (e.g., sustained VT/VF, long QT, HCM, LVEF ≤35% in specified ischemic/non‑ischemic cardiomyopathies, or as a bridge when ICD implantation is delayed/after explant), but WCDs are not covered for post‑MI patients without severe LV dysfunction and are not medically necessary when non‑arrhythmic risk or life expectancy <6 months predominates. Coverage requires documentation of the numeric LVEF and qualifying diagnosis/timing (e.g., >4 weeks after MI and ≥4 weeks before an EP study for EP‑based indications, NIDCM >3 months), evidence the patient can use/respond to a WCD (and a trained home caregiver for E0617), periodic re‑assessment at least every 3 months, and adherence to rental/authorization limits (initial up to 3 months, continued 1–3 month approvals) with replacements only for malfunction/manufacturer recommendation.