1/31/2024 0 Comments Heart passmakerSinus bradycardia associated with major symptoms (e.g., syncope, seizures, congestive heart failure) or substantial sinus bradycardia (heart rate less than 50) associated with dizziness or confusion. Second degree AV heart block of Type I (i.e., progressive prolongation of P-R interval prior to each blocked beat) with significant symptoms due to hemodynamic instability associated with the heart block.ĥ. Second degree AV heart block of Type II (i.e., no progressive prolongation of P- R interval prior to each blocked beat).Ĥ. Congenital complete heart block with severe bradycardia (in relation to age), or significant physiological deficits or significant symptoms due to the bradycardia.ģ. Acquired complete (also referred to as third degree) AV heart block.Ģ. (In cases where there is a rhythm disturbance, if the rhythm disturbance is chronic or recurrent, a single episode of a symptom such as syncope or seizure is adequate to establish medical necessity.)ġ. GROUP I: SINGLE-CHAMBER CARDIAC PACEMAKERS Effective for services rendered on or after March 16, 1983.Ĭonditions under which implantation of a cardiac pacemaker is generally considered acceptable or necessary, provided that the conditions are chronic or recurrent and not due to transient causes such as acute myocardial infarction, drug toxicity, or electrolyte imbalance. ![]() ![]() Dual-Chamber Cardiac Pacemakers A) conditions under which dual- chamber pacemaker claims may be considered covered without further claims development, and B) conditions under which dual-chamber pacemaker claims would be denied unless further claims development shows that they fall into the covered categories for single-and dual-chamber pacemakers, or special medical circumstances exist sufficient to convince the contractor that the claim should be paid. Group I: Single-Chamber Cardiac Pacemakers A) conditions under which single- chamber pacemaker claims may be considered covered without further claims development and B) conditions under which single-chamber pacemaker claims would be denied unless further claims development shows that they fall into the covered category, or special medical circumstances exist sufficient to convince the contractor that the claim should be paid. However, as a general rule, contractors may view the two groups of current medical concepts below as representing: As with other guidelines, final coverage determinations must take account of the circumstances of the particular claim, as well as factors such as the medical history of the individual patient. These are intended as guidelines for Medicare contractors to use in assessing the medical necessity of claims for pacemaker implantation. The two groups of conditions outlined below deal with the necessity for cardiac pacemaker implants for patients in general. It should be noted that this instruction applies only to permanent, implanted pacemakers, and does not address the use of temporary, nonimplanted pacemakers. Consequently, judgments about the medical necessity and acceptability of pacemaker implants can be expected to change, and instructions modified as more information becomes available. As with other areas of medicine, advances in knowledge and techniques in cardiology are expected. These guidelines represent current concepts regarding medical circumstances in which pacemaker implantation may be appropriate or necessary. Although significant complications and adverse side effects of pacemakers are relatively rare, they cannot be ignored when considering the use of pacemakers for dubious medical conditions, or marginal clinical benefit. The appropriateness of such implants may be conditional on other diagnostic or therapeutic modalities having been undertaken. While some uses of pacemakers represent relatively certain or unambiguous usage, many others require considerable expertise and judgmentĬonsequently, the medical necessity for pacemaker implantation must be viewed in the context of the overall management of the particular patient. These guidelines are based on certain assumptions regarding the clinical goals of pacemaker implantation. Services rendered for pacemaker implantations on or after the effective dates of this instruction are subject to the guidelines of this section. While cardiac pacemakers have been covered under Medicare for many years, until recently there have been no specific guidelines for their implantation other than the general Medicare requirement that covered services be reasonable and necessary for the treatment of the condition. ![]() Cardiac pacemakers are covered as prosthetic devices under the Medicare program, subject to the conditions and limitations described in this section.
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