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National Coverage Determination (NCD) for Anesthesia in Cardiac Pacemaker Surgery (10.6)

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Benefit Category
Inpatient Hospital Services
Outpatient Hospital Services Incident to a Physician's Service
Physicians' Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Indications and Limitations of Coverage

The use of general or monitored anesthesia during transvenous cardiac pacemaker surgery may be reasonable and necessary and therefore covered under Medicare only if adequate documentation of medical necessity is provided on a case-by-case basis. The Medicare Administrative Contractor obtains advice from its medical consultants or from appropriate specialty physicians or groups in its locality regarding the adequacy of documentation before deciding whether a particular claim should be covered.

A second type of pacemaker surgery that is sometimes performed involves the use of the thoracic method of implantation, which requires open surgery. Where the thoracic method is employed, general anesthesia is always used and should not require special medical documentation.


Transmittal Number

29

Revision History

01/1988 - Deleted existing noncoverage policy for acute myocardial infarction. Effective date 01/16/1988. (TN 21)

07/1988 - Covered use of general or monitored anesthesia during transvenous cardiac pacemaker surgery on a case-by-case basis when adequate documentation of medical necessity is provided. Effective date 07/27/1988. (TN 29)


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