Implantable Cardioverter Defibrillators (ICDs)

Medicare covers ICD implantation for patients with prior sustained VT/VF not due to acute or reversible causes; for secondary prevention after prior MI when LVEF ≤0.30; for primary prevention in severe ischemic or non‑ischemic dilated cardiomyopathy with NYHA class II–III and LVEF ≤35% (non‑ischemic patients must have ≥3 months of optimal medical therapy); and for high‑risk familial/genetic arrhythmia syndromes. Coverage excludes NYHA class IV, recent CABG/PCI within 3 months, recent MI within 40 days, candidates for coronary revascularization, significant irreversible brain damage, non‑cardiac disease with life expectancy <1 year, and uncontrolled supraventricular tachycardia; a documented shared decision making encounter and specified LVEF testing are required prior to initial implantation. ICD replacements are covered for battery end‑of‑life/ERI or device/lead malfunction; bridge‑to‑transplant and other non‑specified indications are subject to local MAC determination or Category B IDE trial rules.