Cardiac Devices - MEDICAID - VIRGINIA

This Humana Virginia Medicaid policy covers implantation and use of cardiac devices — including transvenous implantable cardioverter‑defibrillators (ICDs), automated external defibrillators (E0617), ambulatory/MCOT ECG monitoring, and related leads — for diagnosis and treatment of life‑threatening ventricular arrhythmias and rhythm monitoring. Coverage is aimed at patients with sustained VT (not due to acute MI or reversible causes), survivors of sudden cardiac arrest due to VF, post‑MI patients with reduced LVEF and qualifying EPS findings, inherited high‑risk arrhythmia syndromes, and ischemic/nonischemic cardiomyopathy (NYHA II–III), but is limited by specific LVEF and timing criteria (e.g., post‑MI intervals), requirement that an ICD be contraindicated for AED coverage, caregiver availability for AED use, and other policy‑specified documentation and transvenous‑system restrictions.

"For documented MI indication, LVEF must be less than or equal to 30%."