Cardiac Devices - MEDICAID - SOUTH CAROLINA

Covers cardiac devices and related services — including external AEDs (HCPCS E0617), implantable device components (e.g., leads), ambulatory ECG/MCOT monitoring, and ICD/pacemaker therapies — for patients with heart failure (NYHA I–IV), arrhythmias (sustained VT, atrial fibrillation), syncope, post‑MI reduced EF and nonischemic dilated cardiomyopathy. Coverage is conditional and requires specific documentation and criteria (e.g., LVEF ≤35% for NIDCM, ≤30% post‑MI, sustained VT not due to reversible causes, NYHA class requirements, caregiver availability for AED use, ICD contraindication/explantation when applicable), may be limited to Humana members, and references applicable HCPCS/CPT codes.

"For IDCM indication: patient must have NYHA Class II or III heart failure."

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