Pacemakers and Cardiac Defibrillators

National Government Services would like to alert providers that although coverage indications of pacemakers and implantable cardiac defibrillators was revised and expanded effective with dates of service on or after 8/13/2013, denials are still being received from the CERT contractor.

Coverage Guidelines

To assist with coverage guidelines, review the CMS Internet-Only Manual (IOM) Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, (229 KB)

• Section 20.4 – Implantable Automatic Defibrillators 
• Section 20.8.3 – Cardiac Pacemakers                 

Look for Covered Indications and make available to physicians; encourage documentation to support coverage indications have been met.

CMS Reminder

In order to address claims processing issues, CMS has instructed MACs to implement this NCD at the local level until CMS is able to revise the formal claims processing instructions.

Reviewed 11/14/2024