NCD - Implantable Cardioverter Defibrillators (ICDs) (20.4)

Cross ReferenceClaims Processing InstructionsTransmittal InformationTransmittal Number211Coverage Transmittal Linkhttps://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R213NCD.pdfRevision History04/2023 - Transmittal 11884 issued March 01, 2023, is being rescinded and replaced by Transmittal 11952, dated, April 12, 2023, to remove the A/B MACs (Part A) and FISS from BR 13070.1 and to revise the NCD 20.4 Implantable Automatic Defibrillators (ICDs) spreadsheet. All other information remains the same. (TN 11952) (CR13070)03/2023 - Transmittal 11832 issued February 02, 2023, is being rescinded and replaced by Transmittal 11884, dated, March 1, 2023 to (1) Business Requirement (BR) 13070.4, NCD 150.3 - delete three non-covered CPT codes added in error and remove reference to ALERT M38; (2) BR 13070.1, NCD 20.4 - clarify that C codes are only payable in the ASC setting; and (3) NCD 220.13 spreadsheet - correct effective date of MSN 21.11 to December 31, 2022 to align with BR 13070.7. All other information remains the same.  (TN 11884) (CR13070)02/2023 - The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11832) (CR12960)11/2022 - The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11676) (CR12960)04/2022 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11391) (CR12606)04/2022 - Transmittal 11264, dated February 10, 2022, is being rescinded and replaced by Transmittal 11342, dated, April 6, 2022 to (1) revise BR 12606.10 instructions for NCD 110.24, (2) BR12606.2, fix typo in NCD 160.18 spreadsheet ICD-10 G40.384, which should be G40.834, and, (3) revise implementation verbiage (no changes to the actual implementation date).  All other information remains the same.  (TN 11342) (CR12606)02/2022 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.(TN 11264) (CR12606)01/2022 - Transmittal 11068, dated October 21, 2021, is being rescinded and replaced by Transmittal 11179, dated, January 12, 2022 to revise the attachment for NCD 110.24, CAR-T, to add business requirement 12480.10.1 by adding generic unspecified procedure codes, to clarify coverage and claims processing in the policy section and to review the implementation date. All other information remains the same. (TN 11179) (CR12480)10/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11068) (CR12480)09/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 11025) (CR12399)08/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. (TN 10963) (CR12399)2/2019 - Transmittal 211, dated December 13, 2018, is being rescinded and replaced by Transmittal 213 dated, February 15, 2019 to change the implementation date from February 26, 2019 to March 26, 2019. All other information remains the same.12/2018 - Transmittal 209, dated November 21, 2018, is being rescinded and replaced by Transmittal 211, dated, December 13, 2018, to add a clarifying note to the policy section of the Business Requirements document that was inadvertently left out. All other information remains the same. (TN 211) (CR10865)11/2018 - This Change Request (CR) and Publication (Pub.) 100-03 Medicare NCD Manual reflects the Agency's final decision dated February 15, 2018, regarding the reconsideration of NCD 20.4, Implantable Cardiac Defibrillators. A subsequent CR will be released at a later date that contains a Pub.100-04 Claims Processing Manual update with accompanying instructions. Until that time, the Medicare Administrative Contractors (MACs) shall be responsible for implementing NCD 20.4.(TN 209) (CR10865)06/2016 - Transmittal 1665, dated May 13, 2016, is being rescinded and replaced by Transmittal 1672 to: (1) 9631.1: Remove FISS responsibility and 1st sentence; (2) 9631.2: Remove additional procedure codes, including 0075T, 0076T; (3) 9631.4: Revise descriptor of dx L59.8; (4) 9631.6: Add deletion of dx C49.10, C65.9, remove deletion of dx C54.9, remove deletion of invalid dx C47.90; (5) 9631.8: Remove deletion of invalid dx C51.29, replace with deletion of dx C50.029; (6) 9631.9: Add deletion of 0V504ZZ, 0V500ZZ, override capability, and contractor discretion verbiage. All other information remains the same. (TN 1672) (CR9631)05/2016 - This change request (CR) is the 7th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, and CR9540. Some are the result of revisions required to other NCD-related CRs released separately.   Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.  (TN 1665) (CR9631)03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.  Implementation date: 10/07/2013 Effective date: 10/1/2015. (TN 1199) (TN 1199) (CR 8197)3/2005 - Expanded national coverage by including new indications. Effective and implementation dates 01/27/2005. (TN 29) (CR 3604)08/2003 - Expanded coverage for coronary artery disease with a documented prior myocardial infarction (MI), a measured left ventricular ejection fraction   0.35, and inducible, sustained ventricular tachyarrhythmia or ventricular fibrillation at electrophysiology study; or documented prior MI and a measured left ventricular ejection fraction  0.30 and a QRS duration of >120 milliseconds. All other indications for defibrillators not otherwise specified remain noncovered except when furnished in accordance with FDA-approved protocols governing Category B Investigational Device Exemption; clinical trials as stated in 42 FR Part 405. Effective and implementation dates 10/01/2003. (TN 173) (CR 2880)04/1999 - Expanded coverage for additional types of cardiac patients. Effective and implementation dates 07/01/1999. (TN 115) (CR 825)01/1986 - Provided coverage to treat life-threatening ventricular tachyarrhythmias. Effective date 01/24/1986. (TN 3)OtherNational Coverage Analyses (NCAs)This NCD has been or is currently being reviewed under the National CoverageDetermination process. The following are existing associations with NCAs, from the NationalCoverage Analyses database.Original Consideration for Implantable Cardioverter Defibrillators (ICDs) (CAG-00157N)First reconsideration for Implantable Defibrillators - Clinical Trials (CAG-00157R)Second reconsideration for Implantable Defibrillators (CAG-00157R2)Third reconsideration for Implantable Defibrillators (CAG-00157R3)Fourth reconsideration for Implantable Cardioverter Defibrillators (CAG-00157R4)Coding Analyses for Labs (CALs)This NCD has been or is currently being reviewed under the National CoverageDetermination process. The following are existing associations with CALs, from the Coding Analyses for Labsdatabase.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 Denial