National Coverage Determination (NCD)

Implantation of Automatic Defibrillators

35-85

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Tracking Information

Publication Number
6
Manual Section Number
35-85
Manual Section Title
Implantation of Automatic Defibrillators
Version Number
1
Effective Date of this Version
07/01/1999
Ending Effective Date of this Version
10/01/2003

Description Information

Benefit Category
Physicians' Services
Prosthetic Devices


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

Item/Service Description

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.

Indications and Limitations of Coverage

Effective for services performed on or after January 24, 1986 through July 1, 1991, the implantation of an automatic defibrillator (ICD-9-CM codes 37.94-37.96 or CPT code 33246) is a covered service only when used as a treatment of last resort for patients who have had a documented episode of life-threatening ventricular tachyarrhythmia or cardiac arrest not associated with myocardial infarction. Patients must also be found, by electrophysiologic testing, to have an inducible tachyarrhythmia that proves unresponsive to medication or surgical therapy (or be considered unsuitable candidates for surgical therapy). It must be emphasized that unless all of the above described conditions and stipulations are met in a particular case, including the inducibility of tachyarrhythmia, etc., implantation of an automatic defibrillator may not be covered.

Effective for services performed on or after July 1, 1991, the implantation of an automatic defibrillator is a covered service for patients who have had a documented episode of life-threatening ventricular tachyarrhythmia or cardiac arrest not associated with myocardial infarction.

Effective for services performed on or after July 1, 1999, the implantation of an automatic defibrillator is also a covered service for patients with the following conditions:

  1. A documented episode of cardiac arrest due to ventricular fibrillation not due to a transient or reversible cause;
  2. Ventricular tachyarrhythmia, either spontaneous or induced, not due to a transient or reversible cause; or,
  3. Familial or inherited conditions with a high risk or life-threatening ventricular tachyarrythmias such as long QT syndrome or hypertrophic cardiomyopathy.
Claims Processing Instructions

Transmittal Information

Transmittal Number
115
Revision History

01/1986 - Provided coverage to treat life-threatening ventricular tachyarrhythmias. Effective date 01/24/1986. (TN 3)

04/1999 - Expanded coverage for additional types of cardiac patients. Effective date 07/01/1999. Effective date 07/01/1999. (TN 115) (CR 825)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Additional Information

Other Versions
Title Version Effective Between
Implantable Cardioverter Defibrillators (ICDs) 4 02/15/2018 - N/A View
Implantable Automatic Defibrillators 3 01/27/2005 - 02/15/2018 View
Implantable Automatic Defibrillators 2 10/01/2003 - 01/27/2005 View
Implantation of Automatic Defibrillators 1 07/01/1999 - 10/01/2003 You are here