NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)

Additional InformationOther VersionsTitleVersionEffective BetweenImplantable Cardioverter Defibrillators (ICDs)507/31/2023 - N/AViewImplantable Cardioverter Defibrillators (ICDs)402/15/2018 - 07/31/2023You are hereImplantable Automatic Defibrillators301/27/2005 - 02/15/2018ViewImplantable Automatic Defibrillators210/01/2003 - 01/27/2005ViewImplantation of Automatic Defibrillators107/01/1999 - 10/01/2003ViewCPT Copyright StatementCPT only copyright 2002-2011 American Medical Association. All rights reserved.CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use.Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein.Reasons for DenialNote: This section has not been negotiated by the Negotiated RuleMaking Committee.It includes CMSs interpretation of its longstanding policies and is included for informational purposes.Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease orinjury are not covered except as explicity authorized by statue.These include exams required by insurance companies, business establishments, government agencies, or other third parties.Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue.Failure to provide documentation of the medical necessity of tests may result in denial of claims.The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests.In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner)through documentation in the physicians office may result in denial.A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessaryif it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentationjustifying the necessity is submitted with the claim.If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied asnot reasonable and necessary, unless it is submitted with documentation justifying increased frequency.Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope oftheir license and in compliance with Medicare requirements will be denied as not reasonable and necessary.Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificatefor the testing performed will result in denial of claims.same spacer from search pagecolrowEmail this document to yourself or someone elseAn asterisk (*) indicates arequired field.This email will be sent from you to therecipient email address(es) you enter.Please do not use this feature to contact CMS.To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottomof every MCD page.*Your Name:*Your Name:*Recipient's Email(s):*Recipient's Email(s):Message:Message:Send EmailCancelPage Help forNCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)CloseIntroductionThis page displays your requested National Coverage Determination (NCD).  The document is broken into multiple sections.  You can use the Contents side panel to help navigate the various sections.National Coverage Determinations (NCDs) are national policy granting, limiting or excluding Medicare coverage for a specific medical item or service.More informationNCDs are developed and published by CMS and apply to all states. NCDs are made through an evidence-based process, with opportunities for public participation. Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). An NCD sets forth the extent to which Medicare will cover specific services, procedures, or technologies on a national basis. Medicare Administrative Contractors (MACs) are required to follow NCDs.Printing a Document to PDFThere are multiple ways to create a PDF of a document that you are currently viewing. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Another option is to use the Download button at the top right of the document view pages (for certain document types).Submit Feedback/Ask a Questioncontainer-fluidGet email updatesSign up to get the latest information about your choice of CMS topics in your inbox. Also, you can decide how often you want to get updates.SIGN UPopens in new windowCMS & HHS WEBSITESMedicare.govopens in new windowMedicaid.govopens in new windowInsureKidsNow.govopens in new windowHealthCare.govopens in new windowHHS.govopens in new windowHELPFUL LINKSAcronymsArchiveContactsGlossaryPrivacy policyRSS FEEDSNewsroomBlogPodcastopens in new windowopens in new windowA federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.7500 Security Boulevard, Baltimore, MD 21244opens in new windowopens in new windowopens in new windowTOOLSWeb policiesopens in new windowPlain languageopens in new windowNo Fear Actopens in new windowFreedom of Information Actopens in new windowInspector Generalopens in new windowFrequently Asked Questions (FAQs)Many questions can be answered on theHelp & Resources pagein the How To Library or by viewing the FAQs below. Please take a look and if you still have questions or would like to leave feedback,contact us!Are you a provider and have a question about billing or coding?Please contact your Medicare Administrative Contractor (MAC). MACs can be found in theMAC Contacts Report.Do you have questions related to the content of a specific Local Coverage Determination (LCD) or an Article?Please contact the Medicare Administrative Contractor (MAC) who owns the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details). MACs can also be can be found in theMAC Contacts Report.Are you a beneficiary and have questions about your coverage?Please call 1-800-Medicare or visitMedicare.govAre you looking for codes? (e.g., CPT/HCPCS, ICD-10)Local CoverageFor the most part, codes are no longer included in the LCD (policy). You will find them in the Billing & Coding Articles. Try using theMCD Searchto find what you're looking for. Enter the code you're looking for in the "Enter keyword, code, or document ID" box.  The list of results will include documents which contain the code you entered.Please Note:For Durable Medical Equipment (DME) MACs only, CPT/HCPCS codes remain located in LCDs. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types.National CoverageNCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM).In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. As clinical or administrative codes change or system or policy requirements dictate, CR instructions are updated to ensure the systems are applying the most appropriate claims processing instructions applicable to the policy.How do I find out if a specific CPT code is covered in my state?Enter the CPT/HCPCS code in theMCD Searchand select your state from the drop down. (You may have to accept the AMA License Agreement.) Look for a Billing and Coding Article in the results and open it. (Or, for DME MACs only, look for an LCD.)  Review the article, in particular the Coding Information section.If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document.  The contractor information can be found at the top of the document in theContractor Information section(expand the section to see the details).If you dont find the Article you are looking for,contact your MAC.Did you receive a Medicare coverage denial?Was your Medicare claim denied?  Here are some hints to help you find more information:1) Check out the Beneficiary card on theMCD Searchpage.2) Try using theMCD Searchand enter your information in the "Enter keyword, code, or document ID" box.  Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code.  Try entering any of this type of information provided in your denial letter.3) Contact yourMAC.4) VisitMedicare.govor call 1-800-Medicare.It is Thursday and the weekly MCD data isnt refreshed?Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. If that doesnt work please contacttechnical support.Are you having technical issues with the Medicare Coverage Database (MCD)?Technical issues include things such as a link is broken, a report fails to run, a page is not displaying correctly, a search is taking an unexpectedly long time to complete. If you are having an issue like this please contacttechnical support.Submit Feedback/Ask a QuestionCancelMCD Session Expiration WarningYour MCD session is currently set to expire in 5 minutes due to inactivity. If your session expires, you will lose all items in your basket and any active searches. If you would like to extend your session, you may select theContinueButton.ContinueCancelReset MCD Search DataIf you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues.OKCancelNoticeYou are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and ArticlesContinueCancelNoticeYou are leaving the CMS MCD and are being redirected toContinueCancelPopper is used with permission under the MIT license: https://github.com/popperjs/popper-core/blob/master/LICENSE.md