On February 12, 2014, the Centers for Medicare and Medicaid (CMS) published MLN Matters Article # MM8525 regarding the revised National Coverage Determination (NCD) on single chamber and dual chamber permanent cardiac pacemakers. This NCD, 20.8.3, concludes that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute. (For example: syncope, seizures, congestive heart failure, dizziness, or confusion.)
Indications and limitations of coverage, medical necessity, CPT-4 codes, ICD-9-CM and ICD-10-CM diagnostic and procedure codes, documentation requirements, and billing guidance for both facility and professional settings are outlined in this NCD. It’s important to note the use of modifier KX (requirements specified in the medical policy have been met) to attest that documentation supports medical necessity as outlined in the NCD.
NCD 20.8.3 is effective for claims with dates of service on or after August 13, 2013, with an implementation date of July 7, 2014. Additional information can be found in CMS Transmittals R161NCD and R2872CP.