What is the National Coverage Determination for pacemakers?
The National Coverage Determination (NCD) for Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD20.8.3) was effective on August 13, 2013, and remains in effect.
Does private insurance cover pacemakers?
Pacemakers have coverage under private insurance if the patient requires the use of the device. Costs can significantly vary depending on the patient’s plan and health needs. Advantage Plans will, at the very minimum, cover pacemakers to the same extent as Medicare coverage.
How do I contact the American Heart Association for pacemakers?
You may also contact us at [email protected]. The National Coverage Determination (NCD) 20.8.3, Single Chamber and Dual Chamber Permanent Cardiac Pacemakers were revised with an effective date of August 13, 2013. The CMS A/B Medicare Administrative Contractors (MACs) have been instructed to implement the NCD at the local level.
Will Medicare pay for a pacemaker battery replacement?
When a pacemaker battery starts wearing down, the patient will need a new pacemaker implanted. Of course, this means undergoing another surgical procedure. Typically, the original pacemaker leads won’t need to replacement during this additional surgery. Medicare covers battery replacements in single and dual chamber pacemakers.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Abstract: The National Coverage Determination (NCD) 20.8.3, Single Chamber and Dual Chamber Permanent Cardiac Pacemakers were revised with an effective date of August 13, 2013. The CMS A/B Medicare Administrative Contractors (MACs) have been instructed to implement the NCD at the local level.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
How long do pacemakers last?
For other conditions, Medicare will approve when necessary. Usually, pacemaker batteries have a 7 to 8-year lifespan. When a pacemaker battery starts wearing down, the patient will need a new pacemaker implanted.
How often should a pacemaker be checked?
Patients should undergo pacemaker checks six weeks post-operation. From that point, these checks should be completed every three to six months to ensure the battery function is acceptable. During these pacemaker checks, physicians will check to see if the device has treated any abnormal heart rhythms and will confirm the battery life is still good.
Why is a pacemaker dangerous?
This condition can become dangerous because the body’s organs don’t receive a constant supply of blood and can become severely damaged. A pacemaker is programmed, especially for the patient’s medical condition and needs. The device is a battery, electrodes, and a generator.
Does Medicare cover biventricular pacemakers?
Medicare Coverage for Biventricular Pacemaker. Biventricular pacemakers work both lower chambers of the heart. Medicare covers biventricular pacemakers but requires regular monitoring of the devices. Biventricular devices are monitored every two weeks within the first month, and every four weeks from that point up until the 7th month.
Can a pacemaker be used to correct heartbeat?
You suffer from health issues that increase the chances of heartbeat complications. The use of a pacemaker can correct heart rhythm. To have a pacemaker inserted, a patient must undergo a surgical procedure.
Does Medtronic Surescan work?
Medtronic Surescan technology creates pacemakers, and your physician may decide to recommend that you. The deciding factors of suitability are your specific heart conditions and other health issues. One lead of the device is put into the right atrium while the other goes into the right ventricle of the heart.
Does Medicare cover transtelephonic monitoring?
Medicare covers transtelephonic monitoring devices when the record is at least thirty seconds long and viewable on an ECG strip. Transtelephonic pacemaker devices are small electronic mechanisms that work hand in hand with the pacemaker. Their job is to transfer the patient’s heart rhythm live over the phone.
Claim Explanation Codes
List of Claim Explanation codes along with a description of the meaning of the code.
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General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act (SSA), §1862 (a) (1) (A), states that no Medicare payment shall be made for items or services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
Article Guidance
Abstract: The National Coverage Determination (NCD) 20.8.3, Single Chamber and Dual Chamber Permanent Cardiac Pacemakers was revised with an effective date of August 13, 2013. The CMS A/B Medicare Administrative Contractors (MACs) have been instructed to implement the NCD at the local level.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Transmittal Information
02/2014 - The purpose of this Change Request (CR) is effective for claims with dates of service on or after August 13, 2013, contractors shall allow payment for nationally covered implanted permanent cardiac pacemakers, single chamber or dual chamber, for the indications outlined in the manuals for this CR.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
