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Issue Number - Name
0093 - Automatic Defibrillators
Review Type
Claim Type
Professional Services (Physician/Non-Physician, Outpatient Hospital, Ambulatory Surgery Center)
Region and State
RAC 1-4
All States
Date Approved


The implantable automatic defibrillator is an electronic device designed to detect and treat life-threatening tachyarrhythmias. The device consists of a pulse generator and electrodes for sensing and defibrillating. Medical documentation will be reviewed for medical necessity to validate that implantable automatic cardiac defibrillators are used only for covered indications.

Affected Code(s)

  • CPT codes: 33240, 33241, 33242, 33243, 33249

Applicable Policy References

  • CMS Pub. 100-03, Chapter 1, Section 20.4
  • CMS Pub. 100-04, Chapter 32, Section 270.1