MRIs for Patients with Implanted Pacemakers Covered

Effective for claims with dates of services on or after July 7, 2011 magnetic resonance imaging (MRI) is a covered service for beneficiaries with implanted pacemakers. The Centers for Medicare & Medicaid Services (CMS) is changing the language in section 220.2.C.1 of the Medicare National Coverage Determination Manual to remove the contraindication for Medicare coverage of MRI for beneficiaries with implanted pacemakers. CMS now considers MRI for beneficiaries with implanted pacemakers reasonable and necessary provided the pacemakers are used according to U.S. Food and Drug Administration (FDA)-approved labeling for use in an MRI environment.

Coders should include modifier KX Requirements specified in the medical policy have been met on the claim line(s) as an attestation by the provider of the service that documentation is on file verifying that FDA-approved labeling requirements are met. CMS Transmittal 134, Change Request (CR) 7441, issued Aug. 26, adds ICD-9 codes V45.01 Cardiac pacemaker and V45.02 Automatic implantable cardiac defibrillator to claims instructions in CMS Transmittal 2171, CR 7296, issued March 4, 2011.

See also Pub. 100-03, NCD Manual, section 220.2, for the MRI coverage policy, and Pub. 100-04, Medicare Claims Processing Manual, chapter 13, section 40, for claims processing instructions.

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