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Issue Number - Name
0078 - Complex Cardiac Pacemaker Review
Review Type
Complex
Claim Type
Outpatient, Ambulatory Surgery Center
Region and State
RAC 1-4
All States
Date Approved
2017-12-12

Description

Documentation will be reviewed to determine if Cardiac Pacemakers meet Medicare coverage criteria, meet applicable coding guidelines, and/or are medically reasonable and necessary.

Affected Code(s)

  • 33206, 33207, 33208

Applicable Policy References

  • Social Security Act, Section 1862(a)(1)(A) 
  • 42 Code of Federal Regulations, Section 405.980(b) and (c)
  • 42 Code of Federal Regulations, Section 405.986
  • CMS Pub. 100-03, Medicare National Coverage Determinations, Chapter 1, Part 1, Section 20.8.3 
  • Cahaba Local Coverage Article, A54949, Effective Date 4/15/2016
  • First Coast Local Coverage, Article, A54926, Effective date 5/1/2016 
  • NGS Local Coverage Article, A54909, Effective Date 4/15/2016
  • Novitas Local Coverage Article, A54982, Effective Date 5/1/2016
  • Palmetto Local Coverage Article, A54831, Effective Date 01/13/2016 
  • WPS Local Coverage Article, A54958, Effective Date 5/15/2016   
  • Annual American Medical Association CPT Manual, Coding Guidelines