Implantable Cardioverter Defibrillators

This policy covers implantation of implantable cardioverter‑defibrillators (ICDs) to prevent or treat life‑threatening ventricular arrhythmias, including primary prevention in ischemic cardiomyopathy (post‑MI ≥40 days with LVEF ≤35% or ≤30% for NYHA I), nonischemic dilated cardiomyopathy with LVEF ≤35% after optimization of medical therapy, hypertrophic cardiomyopathy with major SCD risk factors, inherited channelopathies (e.g., long QT, Brugada, short QT, CPVT) at high risk, and survivors of sudden cardiac arrest or sustained VT (including selected pediatric survivors). Coverage is limited to adults (with select pediatric provisions), requires exclusion of reversible causes, meaningful survival >1 year and optimization of therapy (and trial of immunosuppression if active inflammation); ICDs are investigational for recent MI (<40 days), recent revascularization (<3 months), NYHA class IV unless CRT‑D eligible, when antibradycardia or antitachycardia pacing is indicated, and many subcutaneous/extravascular ICD uses are considered experimental except per specific criteria.