evekhm/cms_iom_500 huggingface dataset:
Article - Billing and Coding: Autonomic Function Tests (A54954)
CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35395, Autonomic Function Tests. Please refer to the LCD for reasonable and necessary requirements.According to a report from Casellini et al (2013), use of an apparatus for testing electrochemical skin conductance (ESC) that "consist of two sets of large-area stainless steel electrodes for the hands and feet that are connected to a computer for recording and data-management purposes. The electrodes are alternately used as an anode or cathode, and a direct current incremental voltage of less than or equal to 4 V is applied to the anode. Through reverse iontophoresis, the device generates voltage to the cathode and a current (intensity of around 0.2 mA) between the anode and cathode proportional to chloride concentration. At low voltages (less than 10 V), the stratum corneum is electrically insulating, and only sweat-gland ducts are conductive [in theory]." The report continues saying the (ESC) "expressed in microSiemens (S), is the ratio between the current generated and the constant DC stimulus (less than or equal to 4 V) applied to the electrodes. . . During the test, patients were required to place their hands and feet on the electrodes and to stand still for 23 min. The device produces ESC results for individual right and left hands and feet. It then calculates an average score between right and left hands and feet. All the ESC results [presented in this study] correspond to the average ESC between right and left sides for both hands and feet. . . Neither special subject preparation nor specially trained medical personnel are required."Coding Guicance
Article - Billing and Coding: Autonomic Function Tests (A54954)
Coding GuicanceNotice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.Sudoscan and similar devices, by definition, do not meet the description of Current Procedural Terminology (CPT) code 95923 in that the subject preparation, environmental requirements, and specially trained medical personnel requirements are not met. Therefore, to bill this type of testing report the unlisted neurological diagnostic CPT code 95999.When submitting claims to Novitas for Sudoscan and similar devices as described above, providers should report CPT code 95999. The word SUDOSCAN or the term ESC (electrochemical skin conductance) must be noted in the narrative/remarks field (Item 19) on the CMS-1500 claim form or the electronic equivalent.Cardiovagal innervation testing should be reported with CPT code 95921.Vasomotor adrenergic innervation testing should be reported with CPT code 95922.Sudomotor function testing should be reported with CPT code 95923.CPT code 95924 represents combined parasympathetic and sympathetic adrenergic function testing.Consistent with CPT direction, CPT code 95924 should not be reported with CPT codes 95921 or 95922.Providers should refer to the current year CPT manual for assistance with the proper reporting for autonomic function testing.
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
CMS National Coverage PolicyIOM-100-03 Medicare National Coverage Determinations Manual Chapter 1  CoverageDeterminations, Part 1, 20.8.3  Single Chamber and Dual Chamber Permanent Cardiac PacemakersDecision Memo for Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3)Article TextThe National Coverage Determination (NCD) 20.8.3, Single Chamber and Dual Chamber Permanent Cardiac Pacemakers, wasrevised 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. The following provides coding and billing instructions for the implementation of NCD 20.8.3. (CMS policy language is initalics.) The NCD Item/Service Description and Indications and Limitations of Coverage are repeated here.Item/Service DescriptionA. GeneralPermanent cardiac pacemakers refer to a group of self-contained, battery operated, implanted devices that send electrical stimulation to the heart through one or more implanted leads. They are often classified by the number of chambers of the heart that the devices stimulate (pulse or depolarize). Single chamber pacemakers typically target either the right atrium or right ventricle. Dual chamber pacemakers stimulate both the right atrium and the right ventricle.The implantation procedure is typically performed under local anesthesia and requires only a brief hospitalization. A catheter is inserted into the chest and the pacemakers leads are threaded through the catheter to the appropriate chamber(s) of the heart. The surgeon then makes a small pocket in the pad of the flesh under the skin on the upper portion of the chest wall to hold the power source. The pocket is then closed with stitches.The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example: syncope, seizures, congestive heart failure, dizziness, or confusion).
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Indications and Limitations of CoverageB. Nationally Covered IndicationsThe following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers:Documented non-reversible symptomatic bradycardia due to sinus node dysfunction, andDocumented non-reversible symptomatic bradycardia due to second degree and/or third degree atrioventricular block.C. Nationally Non-Covered IndicationsThe following indications are non-covered for implanted permanent single chamber or dual chamber cardiac pacemakers:Reversible causes of bradycardia such as electrolyte abnormalities, medications or drugs, and hypothermia,Asymptomatic first degree atrioventricular block,Asymptomatic sinus bradycardia,Asymptomatic sino-atrial block or asymptomatic sinus arrest,Ineffective atrial contractions (e.g., chronic atrial fibrillation or flutter, or giant left atrium) without symptomatic bradycardia,Asymptomatic second degree atrioventricular block of Mobitz Type I unless the QRS complexes are prolonged or electrophysiological studies have demonstrated that the block is at or beyond the level of the His Bundle (a component of the electrical conduction system of the heart),Syncope of undetermined cause,Bradycardia during sleep,Right bundle branch block with left axis deviation (and other forms of fascicular or bundle branch block) without syncope or other symptoms of intermittent atrioventricular block,Asymptomatic bradycardia in post-myocardial infarction patients about to initiate long-term beta-blocker drug therapy,Frequent or persistent supraventricular tachycardias, except where the pacemaker is specifically for the control of tachycardia, andA clinical condition in which pacing takes place only intermittently and briefly, and which is not associated with a reasonable likelihood that pacing needs will become prolonged.D. OtherA/B MACs will determine coverage under section 1862(a)(1)(A) of the Social Security Act for any other indications for the implantation and use of single chamber or dual chamber cardiac pacemakers that are not specifically addressed in this national coverage determination.(This NCD last reviewed August 2013).
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Please note:The "Decision Memo for Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemaker (CAG-00063R3)" states:CMS initiated this current national coverage analysis to reconsider coverage indications for single chamber and dual chamber cardiac pacemakers. The scope of this reconsideration and this decision memorandum does not address biventricular pacemakers, pacemakers that stimulate more than two heart chambers, those devices used to treat tachyarrhythmias and cardiac dyssynchrony, cardiac resynchronization therapy, cardiac pacemaker evaluation services, or self-contained pacemaker monitors.Medicare Administrative Contractors will determine coverage under section 1862(a)(1)(A) of the Social Security Act for any other indications for the implantation and use of single chamber or dual chamber cardiac pacemakers that are not specifically addressed in this national coverage determination.This coding and billing guideline only applies to those CPT codes for theinitial insertionof cardiac pacemakers:33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial33207 ventricular33208 atrial and ventricularThe NCDdoes notaddress replacement of PACEMAKER GENERATORS. CPT codes 33227, 33228, 33229 or 33233 are therefore, not addressed in this coding article.Group 1-CMS NCD Covered Conditions and Diagnosis Codes:Documented non-reversible symptomatic bradycardia due to sinus node dysfunctionDocumented non-reversible symptomatic bradycardia due to second degree and/or third degreeatrioventricular blockDiagnosis Codes (Attest with Modifier -KX):Atrioventricular (AV) block (I44.2)Mobitz (type II) AV block (I44.1)Other second-degree AV block (I44.1)Sinoatrial node dysfunction/Sick sinus syndrome (I49.5)Congenital heart block (Q24.6)Group 2-Contractor Additional Diagnosis Codes (Attest with Modifier -KX):
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Group 2-Contractor Additional Diagnosis Codes (Attest with Modifier -KX):Atrioventricular block, unspecified (Symptomatic) (I44.30)First-degree atrioventricular block (Symptomatic with PR interval more than 300 milliseconds) (I44.0)Left bundle branch block, unspecified (I44.7)Right bundle branch block, unspecified or other (I45.10 / I45.19)Bundle branch block, unspecified (I45.10 or I45.19)Right bundle branch block and left posterior fascicular block (I45.2)Right bundle branch block and left anterior fascicular block (I45.2)Other bilateral bundle branch block (I45.2)Bifascicular block (I45.2)Trifascicular block (I45.3)Supraventricular tachycardia in which a pacemaker is specifically for control of the tachycardia (I47.10/I47.19/I47.9)Paroxysmal supraventricular tachycardia/supraventricular tachycardia (SVT that is reproducibly terminated by pacing when catheter ablation and/or drugs fail to control the arrhythmia or produce intolerable side effects) (I47.10/I47.19/I47.9)Atrial fibrillation-persistent; or unspecified atrial fibrillation with symptomatic bradycardia due to necessary medical therapy (I48.1/I48.91)Atrial flutter-typical/atypical/unspecified with symptomatic bradycardia due to necessary medical therapy (I48.3/I48.4/I48.92)Hypersensitive carotid sinus syndrome and neurocardiogenic syncope (syncope without clear, provocative events and with a hypersensitive cardioinhibitory response of 3 seconds or longer) or for significantly symptomatic neurocardiogenic syncope associated with bradycardia documented spontaneously or at the time of tilt-table testing (G90.01)
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Modifier Usage:Modifier  KX must be used as an attestation by the practitioner and/or provider of the service that documentation is on file verifying the patient has a symptomatic arrhythmia or a high potential for progression of the rhythm disturbance requiring a permanent pacemaker forGroups 1 and 2. Bradycardia that is the consequence of essential long-term drug therapy of a type and dose for which there is no acceptable alternativedoes not excludethe use of modifier  KX.In addition, use of modifier  KX may be used in patients without symptoms from Group 1 and 2 in the following situations:
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Awake, symptomfree patients in sinus rhythm, with documented periods of asystole greater than or equal to 3.0 seconds or any escape rate less than 40 beats per minute (bpm), or with an escape rhythm that is below the AV node (I44.1/I44.2)Awake, symptom-free patients with atrial fibrillation and bradycardia with one or more pauses of at least 5 seconds or longer (I44.1/I49.5)Catheter ablation of the AV junction (I44.1/I44.2)Postoperative AV block that is not expected to resolve after cardiac surgery (I44.1/I44.2)Patients with neuromuscular diseases, e.g., myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb dystrophy, and peroneal muscular atrophy, with third-degree and advanced second-degree AV block at any anatomic level (I44.1/I44.2)Asymptomatic persistent third-degree AV block at any anatomic site with average awake ventricular rates of 40 bpm or faster if cardiomegaly or LV dysfunction is present or if the site of block is below the AV node (I44.1/I44.2)Second or third-degree AV block during exercise in the absence of myocardial ischemia (I44.1/I44.2)Persistent third-degree AV block with an escape rate greater than 40 bpm in asymptomatic adult patients without cardiomegaly (I44.2)Asymptomatic second-degree AV block at intra-or infra-His levels found at electrophysiological study (I44.1)First- or second-degree AV block with symptoms similar to those of pacemaker syndrome or hemodynamic compromise (I44.0/I44.1)Asymptomatic type II second-degree AV block with a narrow QRS and second-degree AV block with a wide QRS including isolated right bundle-branch block (I44.1)
Article - Billing and Coding: Single Chamber and Dual Chamber Permanent Cardiac Pacemaker (A54958)
Note: Other Conditions Not Addressed by the NCD or by the Contractor include but are not limited to the following. Medically necessary procedures for the conditions listed below may be allowed. (Attest with Modifier -SC-Medically necessary service or supply):Cardiac resynchronization therapyObstructive hypertrophic cardiomyopathyPacing in children, adolescents, and patients with congenital heart diseasePacemaker or generator replacementsSustained pause-dependent ventricular tachycardia, with or without QT prolongationPacemaker claims that do not have a KX or SC modifier will be returned to provider as incomplete.Pacemaker claims that do not meet the criteria for modifier KX or SC should have modifier GA or GZ appended (depending on ABN status) and will be denied.
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
htmlRequired meta tagsNCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision MemoBootstrap is used with permission under the MIT license: https://github.com/twbs/bootstrap/blob/master/LICENSEjQuery is used with permission under the MIT license: https://jquery.org/license/New RelicThe page could not be loaded. The CMS.gov Web site currently does not fully support browsers with"JavaScript" disabled. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with"JavaScript" disabled.Instructions for enabling "JavaScript" can be found here.Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.Skip to main contentAn official website of the United States governmentHere's how you knowHere's how you knowThe .gov means it's official.Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.The site is secure.Thehttps://ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.Resource NavigationSearchReportsDownloadsArchiveAPIopens in new window<button id="toggle-mobile-search" class="mobile-search-btn" aria-expanded="false"><span class="ds-u-visibility--screen-reader">Toggle Mobile Search</span></button>Close SearchCenters for Medicare & Medicaid ServicesMain headerAbout UsNewsroomData & ResearchMCDMedicare Coverage DatabaseSearchReportsNational CoverageWhat's New ReportAnnual ReportNCA/CAL ReportsNCA/CAL Status ReportNCA/CAL Open for Public Comment ReportNCD ReportMedicare Coverage Documents ReportsMedicare Coverage Documents ReportMed Cov Docs Open for Public Comment ReportOther National Coverage ReportsMEDCAC Meetings ReportTechnology Assessments ReportLocal CoverageWhat's New ReportFinal LCD ReportsFinal LCDs by Contractor ReportFinal LCDs by State ReportFinal LCDs Alphabetical ReportProposed LCD ReportsProposed LCDs by Contractor ReportProposed LCDs by State ReportProposed LCDs Alphabetical ReportArticle Reports
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
Final LCD ReportsFinal LCDs by Contractor ReportFinal LCDs by State ReportFinal LCDs Alphabetical ReportProposed LCD ReportsProposed LCDs by Contractor ReportProposed LCDs by State ReportProposed LCDs Alphabetical ReportArticle ReportsArticles by Contractor ReportArticles by State ReportArticles Alphabetical ReportSAD Exclusion List ReportMAC Contacts ReportDownloadsHelp & ResourcesPage HelpTour the SearchTour the ReportsContact UsReset Search DataArchiveAPIBack to Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac PacemakersContentsDecision SummaryProposedDecision MemoBibliographyRelated MaterialNational Coverage Analysis (NCA)ProposedDecision MemoCardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac PacemakersCAG-00063R3Expand All|Collapse AllDownloadDecision SummaryThe Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example: syncope, seizures, congestive heart failure, dizziness, or confusion).Therefore, the following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers:Documented non-reversible symptomatic bradycardia due to sinus node dysfunction.Documented non-reversible symptomatic bradycardia due to second degree and/or third degree atrioventricular block.The following indications are non-covered since there is insufficient evidence to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary:
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
The following indications are non-covered since there is insufficient evidence to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary:Reversible causes of bradycardia such as electrolyte abnormalities, medications or drugs, and hypothermia.Asymptomatic first degree atrioventricular block.Asymptomatic sinus bradycardia.Asymptomatic sino-atrial block or asymptomatic sinus arrest.Ineffective atrial contractions (e.g., chronic atrial fibrillation or flutter, or giant left atrium) without symptomatic bradycardia.Asymptomatic second degree atrioventricular block of Mobitz Type I unless the QRS complexes are prolonged or electrophysiological studies have demonstrated that the block is at or beyond the level of the His Bundle (a component of the electrical conduction system of the heart).Syncope of undetermined cause.Bradycardia during sleep.Right bundle branch block with left axis deviation (and other forms of fascicular or bundle branch block) without syncope or other symptoms of intermittent atrioventricular block.Asymptomatic bradycardia in post-myocardial infarction patients about to initiate long-term beta-blocker drug therapy.Frequent or persistent supraventricular tachycardias, except where the pacemaker is specifically for the control of the tachycardia.A clinical condition in which pacing takes place only intermittently and briefly, and which is not associated with a reasonable likelihood that pacing needs will become prolonged.Medicare Administrative Contractors will determine coverage under section 1862(a)(1)(A) of the Social Security Act for any other indications for the implantation and use of single chamber or dual chamber cardiac pacemakers that are not specifically addressed in this national coverage determination.ProposedDecision Memo
NCA - Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3) - Decision Memo
ProposedDecision MemoTo:Administrative File: CAG-00063R3  From:Louis Jacques, MD Director, Coverage and Analysis Group  Tamara Syrek Jensen, JD Deputy Director, Coverage and Analysis Group  Jyme Schafer, MD, MPH Director, Division of Medical and Surgical Services  Joseph Chin, MD, MS Lead Medical Officer  Jamie Hermansen, MPP Lead Health Policy Analyst  Subject:Decision Memorandum for Reconsideration of Coverage of Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers.   Date:August 13, 2013I.  DecisionThe Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block.  Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example:  syncope, seizures, congestive heart failure, dizziness, or confusion).Therefore, the following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers:Documented non-reversible symptomatic bradycardia due to sinus node dysfunction.Documented non-reversible symptomatic bradycardia due to second degree and/or third degree atrioventricular block.The following indications are non-covered since there is insufficient evidence to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary: