Local Coverage Determination (LCD)

Cardiac Rhythm Device Evaluation

L34833

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Contractor Information

LCD Information

Document Information

LCD ID
L34833
LCD Title
Cardiac Rhythm Device Evaluation
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 08/13/2020
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Copyright © 2013 - 2021, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

CMS National Coverage Policy

This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for cardiac rhythm device evaluation services. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for cardiac rhythm device evaluation services and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site.

IOM Citations:

  • CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1,
    • Section 20.8.1 Cardiac Pacemaker Evaluation Services
    • Section 20.8.1.1 Transtelephonic Monitoring of Cardiac Pacemakers
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provisions in LCDs

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

 Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.

History/Background and/or General Information

Electronic analysis to monitor the patient’s pacemaker or cardioverter-defibrillator is medically necessary on a regular basis to evaluate the device. Pre and postoperative evaluation of the cardiac rhythm device in patients with implantable cardioverter-defibrillators (ICDs) or who are pacer dependent may be necessary because electromagnetic interference can alter the function of these devices, especially ICDs, in unpredictable ways. They may need to be re-programmed before and after a surgical procedure.

Covered Indications and Limitations

Please refer to NCD 20.8.1 Cardiac Pacemaker Evaluation Services for indications and limitations of coverage for the post-implant follow-up and evaluation of implanted cardiac pacemakers.

Transtelephonic Monitoring of Cardiac Pacemakers

Please refer to NCD 20.8.1.1 Transtelephonic Monitoring of Cardiac Pacemakers for general information, definition of transtelephonic monitoring, frequency guidelines for transtelephonic monitoring, and pacemaker clinic services.

For instances where a patient is monitored both during clinic visits and remotely or transtelephonically, the combined frequency of monitoring will be considered in evaluating the reasonableness of the frequency of monitoring services received by the patient.

Note: Payment for dual-chamber pacemakers operating in single-chamber mode should be made at the same frequency as monitoring of a single-chamber pacemaker.

Local Medicare Frequency Guidelines for Monitoring of Cardioverter-Defibrillators

Electronic analysis of a pacing cardioverter-defibrillator is performed in an office or outpatient hospital setting. It involves the interrogation and evaluation of the pulse generator status in addition to evaluation of the programmable parameters, analysis of event markers, and device response during periods of rest and activity. The monitoring of these complex devices requires more frequent monitoring than a single- or dual-chamber pacemaker. Therefore, Medicare will allow routine electronic analysis of a pacing cardioverter-defibrillator (single- and dual-chamber) within one month following implantation and then every three months thereafter. More frequent testing may be necessary to evaluate patient symptoms suggestive of pacing cardioverter-defibrillator involvement/origin.

Wearable Defibrillator System

Payment for wearable defibrillators is made by Durable Medical Equipment (DME) contractors and is subject to the indications and limitations in the DME Local Coverage Determination “Automatic External Defibrillators.”

Coverage (including frequency) for monitoring the wearable system is identical to that of implantable defibrillator devices.

Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in this LCD.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

General Information

Associated Information


Refer to the related Local Coverage Article: Billing and Coding: Cardiac Rhythm Device Evaluation, A56602, for all coding information.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care of the patient.
  3. The medical record documentation must support the medical necessity of the services as stated in this policy.
  4. When services are performed by entities other than the attending physician, such as monitoring services and pacemaker clinics, it is expected that the information obtained from these monitoring activities be communicated to the attending physician for use in the management of the patient's condition. This information must be documented in the patient's medical record.


Utilization Guidelines


In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.


Please refer to NCD 20.8.1 for national frequency guidelines for transtelephonic monitoring of cardiac pacemakers.


Please refer to the "Covered Indications and Limitations" section of this LCD for local frequency guidelines for monitoring of cardioverter-defibrillators.

Sources of Information


Contractor is not responsible for the continued viability of websites listed.

Other Contractor(s)' Policies

Contractor Medical Directors

Bibliography

N/A

Revision History Information

Revision History DateRevision History NumberRevision History ExplanationReasons for Change
08/13/2020 R17

LCD revised and published on 08/13/2020 as a non-substantive revision to remove the following language from the ‘Covered Indications and Limitations’ section: Appropriate frequency of monitoring of cardiac rhythm devices should be determined by the physician based upon multiple factors. Payment for services provided at a frequency that exceeds the national frequency guidelines may be made by Medicare upon medical review if medical reasonableness and necessity for the services are documented. Also, the following language was moved from the ‘Covered Indications and Limitations’ section to the ‘Documentation Requirements’ section: When services are performed by entities other than the attending physician, such as monitoring services and pacemaker clinics, it is expected that the information obtained from these monitoring activities be communicated to the attending physician for use in the management of the patient's condition. This information must be documented in the patient's medical record. Also, minor formatting changes were made throughout.

  • Other (Non-substantive revision)
10/17/2019 R16

LCD revised and published on 10/17/2019. Consistent with CMS Change Request 10901, the entire coding section has been removed from the LCD and placed into the related Billing and Coding Article, A56602. All CPT codes and coding information within the text of the LCD has been placed in the Billing and Coding Article.

The following has been removed from the Documentation Requirements: The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

  • Other (CMS Change Request 10901)
06/13/2019 R15

LCD revised and published on 06/13/2019. All billing and coding related information, including the CPT and ICD-10 codes, has been moved to the Local Coverage Article: Billing and Coding: Cardiac Rhythm Device Evaluation (A56602). There has been no change to coverage in this policy with this revision.

  • Other (Change in LCD process per CR 10901)
01/01/2019 R14

LCD revised and published on 02/14/2019 effective for dates of service on and after 01/01/2019 to reflect the annual CPT/HCPCS code updates. For the following CPT/HCPCS code(s) either the short description and/or the long description has been changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document: 93279, 93286, 93288, 93294, and 93296.

CMS IOM and NCD language was removed from the body of the LCD. The NCD language was replaced with citations for the applicable NCD references (reference CR 10901). Updates have been made to the references in the CMS National Coverage Policy section. Added references to the Utilization Guideline section for applicable national and local frequency guidelines.

  • Revisions Due To CPT/HCPCS Code Changes
  • Other (Clarification)
10/01/2018 R13

LCD revised and published on 10/25/2018 effective for dates of service on and after 10/01/2018 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code(s) have been deleted and therefore removed from the LCD: R93.8. The following ICD-10-CM code(s) have been added to the LCD Group 2 codes: R93.89.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; therefore, not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To ICD-10-CM Code Changes
06/14/2018 R12

LCD revised and published on 06/14/2018 to remove the effective date for the CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services and to amend the term and acronym under Transtelephonic Monitoring of Cardiac Pacemakers.
 
At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; therefore, not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
10/01/2017 R11

LCD revised and published on 10/05/2017 effective for dates of service on and after 10/01/2017 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the LCD: Group 1 codes I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.83, I50.84, and I50.89. Group 2 code: I21.9.The following ICD-10-CM code has undergone a descriptor change: Group 1 code: I50.1.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; therefore, not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To ICD-10-CM Code Changes
05/11/2017 R10

LCD revised and published on 06/08/2017 to correct IOM publication number for the CMS Medicare Benefit Policy Manual.

  • Typographical Error
05/11/2017 R9 LCD revised and published on 05/11/2017 to update IOM citations.
  • Other (Update IOM Citations)
10/01/2016 R8 LCD revised and published on 09/29/2016 effective for dates of service on and after 10/01/2016 to reflect the ICD-10 Annual Code Updates. The following ICD-10 code(s) have undergone a descriptor change: T82.817A, T82.827A, T82.837A, T82.847A, T82.857A, and T82.867A.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R7 LCD revised and published on 02/11/2016 for dates of service on and after 10/01/2015 to add the following ICD-10 codes to the Group 2 codes as covered diagnoses: I42.0, I49.3, and I49.9. Also updated the NCD references to include NCD 20.4.
  • Other (Inquiry and Clarification)
10/01/2015 R6 LCD revised and published on 10/29/2015 effective for dates of service on and after 10/01/2015 to include additional ICD-10 diagnoses for coverage.
  • Other (Clarification)
10/01/2015 R5 LCD revised and published on 3/26/2015 to correct typographical errors.
  • Typographical Error
10/01/2015 R4 LCD revised to provide clarification regarding the frequency for reporting CPT codes 93293-93296.
  • Other (Clarification )
10/01/2015 R3 LCD revised and published 01/23/2015 to correct the publication date of the annual CPT/HCPCS code updates incorrectly listed as 01/22/2015 in revision history below. The code updates remain as listed in the revision history below.
  • Revisions Due To CPT/HCPCS Code Changes
  • Typographical Error
10/01/2015 R2 LCD revised and published on 01/22/2015 to reflect the annual CPT/HCPCS code updates. CPT codes 93260 and 93261 have been added as covered services when used with diagnosis in group 2. For the following CPT/HCPCS codes either the short description and/or the long description was changed: 93282; 93283; 93284; 93287; 93289; 93295 and 93296. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document. CPT/HCPCS codes changed to short descriptors.
  • Revisions Due To CPT/HCPCS Code Changes
10/01/2015 R1 LCD revised on 10-09-2014 and posted on 12-04-2014 to create uniform LCD with other MAC jurisdiction.
  • Creation of Uniform LCDs With Other MAC Jurisdiction

Associated Documents

Attachments
N/A
Related Local Coverage Documents
Articles
A56602 - Billing and Coding: Cardiac Rhythm Device Evaluation
Public Versions
Updated On Effective Dates Status
08/07/2020 08/13/2020 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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