Cardiac Devices - MEDICAID - OHIO

This Humana Medicaid (Ohio) coverage policy (effective 12/03/2025) covers automated external defibrillators (E0617) only when ICD therapy is contraindicated or an implanted ICD requires explantation, a capable caregiver is available, and the member meets specific cardiac risk criteria (eg, documented SCA due to VF, qualifying MI with low LVEF and inducible VT/VF, inherited high‑risk conditions, ischemic/nonischemic cardiomyopathy with reduced LVEF and NYHA II–III, sustained VT). Cardioverter‑defibrillator implantation or replacement is covered when medically necessary. Mobile Cardiac Outpatient Telemetry (CPT 93228/93229) is covered for infrequent/unpredictable symptoms needing prolonged monitoring, recurrent unexplained syncope with nondiagnostic initial evaluation, or suspected paroxysmal AF after cryptogenic stroke when results would guide anticoagulation; uses outside these specified indications are not covered.

"Documentation excluding irreversible brain damage or noncardiac disease with life expectancy <1 year when applicable"