Leadless Cardiac Pacemakers

This policy covers leadless transcatheter cardiac pacemakers (e.g., Micra and Aveir systems) for patients needing single‑ or selected dual‑chamber pacing such as high‑grade AV block (including with atrial fibrillation), significant bradycardia/sick sinus syndrome/recurrent Adams‑Stokes, or when conventional transvenous leads are contraindicated or not feasible (prior endovascular/CIED infection, venous occlusion/anomalies, planned/used hemodialysis AV fistula, tricuspid valve pathology, anatomic or lifestyle reasons). Coverage is limited to the policy’s specified, FDA‑informed indications and requires device‑specific precautions (certain models contraindicated with IVC filters, mechanical tricuspid valves, or co‑implanted ICDs), MRI‑conditional use per manufacturer guidance, adequate femoral venous anatomy for implantation, and heart‑team assessment for tricuspid replacement risk; use outside criteria is considered experimental/investigational.

"High-grade AV block in the presence of atrial fibrillation or significant bradycardia AND normal sinus rhythm with episodes of 2nd-degree or 3rd-degree AV block or sinus arrest."