Local Coverage Article Billing and Coding

Billing and Coding: Implantable Automatic Defibrillators

A56342

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General Information

Article ID
A56342
Article Title
Billing and Coding: Implantable Automatic Defibrillators
Article Type
Billing and Coding
Original Effective Date
03/26/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

N/A

Article Guidance

Article Text

The National Coverage Determination (NCD) 20.4, Implantable Automatic Defibrillators was revised with an effective date of February 15, 2018. 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 20.4. (CMS policy language is in italics.) The NCD “Item/Service Description” and “Indications and Limitations” are repeated here.

This article does not alter previous CMS A/B Medicare Administrative Contractors (MACs) instructions for coding and billing of NCD 20.8.3 (National Coverage Determination (NCD) for Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers) nor does it alter MAC Local Coverage for Cardiac Resynchronization Therapy.

Item/Service Description

A. General An ICD is an electronic device designed to diagnose and treat life-threatening ventricular tachyarrhythmias.

Indications and Limitations of Coverage

B. Nationally Covered Indications

Effective for services performed on or after February 15, 2018, CMS has determined that the evidence is sufficient to conclude that the use of ICDs, (also referred to as defibrillators) is reasonable and necessary:

1. Patients with a personal history of sustained Ventricular Tachyarrhythmia (VT) or cardiac arrest due to Ventricular Fibrillation (VF). Patients must have demonstrated:

  • An episode of sustained VT, either spontaneous or induced by an Electrophysiology (EP) study, not associated with an acute Myocardial Infarction (MI) and not due to a transient or reversible cause; or
  • An episode of cardiac arrest due to VF, not due to a transient or reversible cause. 

ICD-10-CM codes which describe the above: I46.2, I46.9, I47.2, I49.01, I49.02, I49.3, I49.9, I5A, Z45.02 or Z86.74.

2. Patients with a prior MI and a measured Left Ventricular Ejection Fraction (LVEF) ≤ 0.30. Patients must not have:

  • New York Heart Association (NYHA) classification IV heart failure; or,
  • Had a Coronary Artery Bypass Graft (CABG), or Percutaneous Coronary Intervention (PCI) with angioplasty and/or stenting, within the past three (3) months; or,
  • Had an MI within the past 40 days; or,
  • Clinical symptoms and findings that would make them a candidate for coronary revascularization. 

For these patients identified in B2, a formal shared decision making encounter must occur between the patient and a physician (as defined in Section 1861(r)(1) of the Social Security Act (the Act)) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act) using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared-decision making encounter may occur at a separate visit.

ICD-10-CM code I25.2 must be billed with one of the following ICD-10-CM codes which describe the above: I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

3. Patients who have severe, ischemic, dilated cardiomyopathy but no personal history of sustained VT or cardiac arrest due to VF, and have NYHA Class II or III heart failure, LVEF ≤ 35%. Additionally, patients must not have:

  • Had a CABG, or PCI with angioplasty and/or stenting, within the past three (3) months; or,
  • Had an MI within the past 40 days; or,
  • Clinical symptoms and findings that would make them a candidate for coronary revascularization. 

For these patients identified in B3, a formal shared decision making encounter must occur between the patient and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act) using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared decision-making encounter may occur at a separate visit.

ICD-10-CM code I25.5 must be billed with one of the following ICD-10-CM codes which describe the above: I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

4. Patients who have severe, non-ischemic, dilated cardiomyopathy but no personal history of cardiac arrest or sustained VT, NYHA Class II or III heart failure, LVEF ≤ 35%, been on optimal medical therapy for at least three (3) months. Additionally, patients must not have:

  • Had a CABG or PCI with angioplasty and/or stenting, within the past three (3) months; or,
  • Had an MI within the past 40 days; or,
  • Clinical symptoms and findings that would make them a candidate for coronary revascularization. 

For these patients identified in B4, a formal shared decision making encounter must occur between the patient and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act) using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared-decision making encounter may occur at a separate visit.

ICD-10-CM codes I42.0, I42.6, I42.7 or I42.8 must be billed with one of the following ICD-10-CM codes which describe the above: I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

5. Patients with documented, familial or genetic disorders with a high risk of life-threatening tachyarrhythmias (sustained VT or VF, to include, but not limited to, long QT syndrome or hypertrophic cardiomyopathy). 

For these patients identified in B5, a formal shared decision making encounter must occur between the patient and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act) using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared decision-making encounter may occur at a separate visit.

ICD-10-CM codes which describe the above: I42.1, I42.2, I45.6, I45.81 or I45.89.

6. Patients with an existing ICD may receive an ICD replacement if it is required due to the end of battery life, Elective Replacement Indicator (ERI), or device/lead malfunction. 

For each of the six (6) covered indications above, the following additional criteria must also be met:

  1. Patients must be clinically stable (e.g., not in shock, from any etiology);
  2. LVEF must be measured by echocardiography, radionuclide (nuclear medicine) imaging, cardiac Magnetic Resonance Imaging (MRI), or catheter angiography;
  3. Patients must not have:
    • Significant, irreversible brain damage; or,
    • Any disease, other than cardiac disease (e.g., cancer, renal failure, liver failure) associated with a likelihood of survival less than one (1) year; or,
    • Supraventricular tachycardia such as atrial fibrillation with a poorly controlled ventricular rate. 

Exceptions to waiting periods for patients that have had a CABG, or PCI with angioplasty and/or stenting, within the past three (3) months, or had an MI within the past 40 days:

Cardiac Pacemakers: Patients who meet all CMS coverage requirements for cardiac pacemakers, and who meet the criteria in NCD 20.4 for an ICD, may receive the combined devices in one procedure, at the time the pacemaker is clinically indicated;

Replacement of ICDs: Patients with an existing ICD may receive an ICD replacement if it is required due to the end of battery life, ERI, or device/lead malfunction. 

ICD-10-CM codes which describe the above: T82.110A, T82.111A, T82.118A, T82.119A, T82.120A, T82.121A, T82.128A, T82.129A, T82.190A, T82.191A, T82.198A, T82.199A, T82.7XXA or Z45.02.

C. Nationally Non-Covered Indications 

N/A

D. Other 

For patients that are candidates for heart transplantation on the United Network for Organ Sharing (UNOS) transplant list awaiting a donor heart, coverage of ICDs, as with cardiac resynchronization therapy, as a bridge-to-transplant to prolong survival until a donor becomes available, is determined by the local Medicare Administrative Contractors (MACs).

 ICD-10-CM code Z76.82 must be billed with ICD-10-CM code I50.84 which describes the above.

All other indications for ICDs not currently covered in accordance with this decision may be covered under Category B Investigational Device Exemption (IDE) trials (42 CFR 405.201).

ICD-10-CM code which describes the above: Z00.6.

NOTE: Effective February 15, 2018, coverage policy is no longer contingent on participation in a trial/study/registry. Therefore, claims with DOS on an after February 15, 2018, no longer require trial-related coding unless they are associated with a Category B IDE trial, in which case Z00.6 must be appended to the claim.

The coding and billing guidelines apply to the following ICD-10-Procedure codes: insertion codes: 0JH608Z, 0JH609Z, 0JH638Z, 0JH639Z, 0JH808Z, 0JH809Z, 0JH838Z, 0JH839Z, 0JH60FZ, 0JH63FZ, 02H43KZ, 02H60KZ, 02H63KZ, 02H64KZ, 02H70KZ, 02H73KZ, 02H74KZ, 02HK0KZ, 02HK3KZ, 02HK4KZ, 02HL0KZ, 02HL3KZ, 02HL4KZ and removal codes: 0JPT0FZ, 0JPT3FZ, 0JPT0PZ, 0JPT3PZ, 02PA0MZ, 02PA3MZ, 02PA4MZ and 02PAXMZ.

The coding and billing guidelines also apply to the following CPT codes: 33202, 33203, 33223, 33230, 33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448, 33215, 33216, 33217, 33218, 33220, 33224 and 33225.

Coding Information

CPT/HCPCS Codes

Group 1

(29 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
33202 INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STERNOTOMY, SUBXIPHOID APPROACH)
33203 INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG, THORACOSCOPY, PERICARDIOSCOPY)
33215 REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR IMPLANTABLE DEFIBRILLATOR (RIGHT ATRIAL OR RIGHT VENTRICULAR) ELECTRODE
33216 INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
33217 INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
33220 REPAIR OF 2 TRANSVENOUS ELECTRODES FOR PERMANENT PACEMAKER OR IMPLANTABLE DEFIBRILLATOR
33223 RELOCATION OF SKIN POCKET FOR IMPLANTABLE DEFIBRILLATOR
33224 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, WITH ATTACHMENT TO PREVIOUSLY PLACED PACEMAKER OR IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR (INCLUDING REVISION OF POCKET, REMOVAL, INSERTION, AND/OR REPLACEMENT OF EXISTING GENERATOR)
33225 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
33230 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING DUAL LEADS
33231 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING MULTIPLE LEADS
33240 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD
33241 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY
33243 REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR ELECTRODE(S); BY THORACOTOMY
33244 REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR ELECTRODE(S); BY TRANSVENOUS EXTRACTION
33249 INSERTION OR REPLACEMENT OF PERMANENT IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER
33262 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; SINGLE LEAD SYSTEM
33263 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; DUAL LEAD SYSTEM
33264 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; MULTIPLE LEAD SYSTEM
33270 INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH SUBCUTANEOUS ELECTRODE, INCLUDING DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR THERAPEUTIC PARAMETERS, WHEN PERFORMED
33271 INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE
33272 REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE
33273 REPOSITIONING OF PREVIOUSLY IMPLANTED SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE
C7537 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH ATRIAL TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEBRIBRILLATOR OR PACEMAKE PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM)
C7538 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH VENTRICULAR TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEFRIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM)
C7539 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH ATRIAL AND VENTRICULAR TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM)
C7540 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR, DUAL LEAD SYSTEM, WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM)
G0448 INSERTION OR REPLACEMENT OF A PERMANENT PACING CARDIOVERTER-DEFIBRILLATOR SYSTEM WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(45 Codes)
Group 1 Paragraph

For inpatient and outpatient institutional claims ICD-10-CM codes I25.2, I25.5, I42.0, I42.6, I42.7, I42.8 and Z76.82 must be reported with a secondary diagnosis as described in the Article Text above.

Group 1 Codes
CodeDescription
I25.2 Old myocardial infarction
I25.5 Ischemic cardiomyopathy
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I45.6 Pre-excitation syndrome
I45.81 Long QT syndrome
I45.89 Other specified conduction disorders
I46.2 Cardiac arrest due to underlying cardiac condition
I46.9 Cardiac arrest, cause unspecified
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.3 Ventricular premature depolarization
I49.9 Cardiac arrhythmia, unspecified
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.84 End stage heart failure
I5A Non-ischemic myocardial injury (non-traumatic)
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.129A Displacement of unspecified cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
Z00.6 Encounter for examination for normal comparison and control in clinical research program
Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator
Z76.82 Awaiting organ transplant status
Z86.74 Personal history of sudden cardiac arrest

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

Group 1

(30 Codes)
Group 1 Paragraph

The following ICD-10 PCS Codes include both the Part A insertion and removal procedure codes.

Procedure code 02PAXMZ remains valid until 9/30/2021. This code will not be valid for dates of service October1, 2021 and forward.

Group 1 Codes
CodeDescription
02H43KZ Insertion of Defibrillator Lead into Coronary Vein, Percutaneous Approach
02H60KZ Insertion of Defibrillator Lead into Right Atrium, Open Approach
02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach
02H64KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Endoscopic Approach
02H70KZ Insertion of Defibrillator Lead into Left Atrium, Open Approach
02H73KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Approach
02H74KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Endoscopic Approach
02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach
02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach
02HK4KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Endoscopic Approach
02HL0KZ Insertion of Defibrillator Lead into Left Ventricle, Open Approach
02HL3KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Approach
02HL4KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Endoscopic Approach
02PA0MZ Removal of Cardiac Lead from Heart, Open Approach
02PA3MZ Removal of Cardiac Lead from Heart, Percutaneous Approach
02PA4MZ Removal of Cardiac Lead from Heart, Percutaneous Endoscopic Approach
0JH608Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH609Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH60FZ Insertion of Subcutaneous Defibrillator Lead into Chest Subcutaneous Tissue and Fascia, Open Approach
0JH638Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH639Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH63FZ Insertion of Subcutaneous Defibrillator Lead into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH808Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH809Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach
0JH838Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
0JH839Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach
0JPT0FZ Removal of Subcutaneous Defibrillator Lead from Trunk Subcutaneous Tissue and Fascia, Open Approach
0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Open Approach
0JPT3FZ Removal of Subcutaneous Defibrillator Lead from Trunk Subcutaneous Tissue and Fascia, Percutaneous Approach
0JPT3PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Percutaneous Approach

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R7

Per Annual CPT/HPCPS Update, effective 01/01/2023 HCPCS codes C7537, C7538, C7539 and C7540 were added to Group 1. 

10/01/2022 R6

Per ICD-10 Annual Update effective 10/01/2022, I47.2 was deleted & replaced with 147.20, I47.21 & I47.29.

10/01/2021 R5

Add diagnosis code I5A to number 1 of the Nationally Covered Indications in the Article Text and the Group 1 ICD-10 diagnosis codes effective 10/01/2021 per CR12480.

The end date for ICD-10-PCS code 02PAXMZ is 09/30/2021 instead of 10/31/2021 stated in Revision History number 4 below.

10/01/2019 R4

Added a hyphen between decision and making throughout the Article Text and the statement “NOTE: Effective February 15, 2018, coverage policy is no longer contingent on participation in a trial/study/registry. Therefore, claims with DOS on an after February 15, 2018, no longer require trial-related coding” to the Article Text. Clarified the statement in Paragraph 1 in the ICD-10 Codes that Support Medical Necessity section to indicate the diagnosis codes are for both inpatient and outpatient services and that the applicable secondary diagnoses for the codes listed are listed in the Article Text. Added the ICD-10-PCS insertion and removal codes in the ICD-10-PCS Codes Section and noted the removal code 02PAXMZ is valid until 10/31/2021.

10/01/2019 R3

Added the generator removal codes 0JPT0PZ and 0JPT3PZ to the Article Text that were erroneously deleted with the previous update.

10/01/2019 R2

Article converted to Billing and Coding, no changes in coverage were made.

10/01/2019 R1

Changed the title to Billing and Coding: Implantable Automatic Defibrillators. Effective 10/01/2019, added the ICD-10-PCS insertion codes 0JH60FZ and 0JH63FZ and removal codes 0JPT0FZ and 0JPT3FZ per the annual ICD-10 updates.

Associated Documents

Related Local Coverage Documents
N/A
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
01/03/2023 01/01/2023 - N/A Currently in Effect You are here
09/02/2022 10/01/2022 - 12/31/2022 Superseded View
11/16/2021 10/01/2021 - 09/30/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • ICD
  • Implantable Cardiac Defibrillator
  • AICD
  • Automated Implantable Cardiac Defibrillator
  • Ventricular Tachyarrhythmia
  • VT
  • Ventricular Fibrillation
  • VF
  • Left Ventricular Ejection Fraction
  • LVEF
  • 33202
  • 33203
  • 33215
  • 33216
  • 33217
  • 33218
  • 33220
  • 33221
  • 33222
  • 33223
  • 33224
  • 33225
  • 33230
  • 33231
  • 33240
  • 33241
  • 33243
  • 33244
  • 33249
  • 33262
  • 33263
  • 33264
  • 33270
  • 33271
  • 33272
  • 33273
  • G0448
  • 0JH608Z
  • 0JH609Z
  • 0JH638Z
  • 0JH639Z
  • 0JH60FZ
  • 0JH63FZ
  • 0JH808Z
  • 0JH809Z
  • 0JH838Z
  • 0JH839Z
  • 02H43KZ
  • 02H60KZ
  • 02H63KZ
  • 02H64KZ
  • 02H70KZ
  • 02H73KZ
  • 02H74KZ
  • 02HK0KZ
  • 02HK3KZ
  • 02HK4KZ
  • 02HL0KZ
  • 02HL3KZ
  • 02HL4KZ
  • 0JPT0FZ
  • 0JPT3FZ
  • 0JPT0PZ
  • 0JPT3PZ
  • 02PA0MZ
  • 02PA3MZ
  • 02PA4MZ
  • 02PAXMZ