New Medicare Coverage for Pacemakers Used to Treat Bradycardia

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  • April 4, 2014
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If your practice sees patients with documented nonreversible symptomatic bradycardia, you should know that the Centers for Medicare & Medicaid Services (CMS) recently established a national coverage determination (NCD) allowing payment for implanted permanent cardiac single- or dual-chamber pacemakers, used for the treatment of this disease.
Coverage is effective for claims with dates of service on or after Aug. 13, 2013. Note, however, that Medicare contractors have until July 7, 2014 to implement this NCD. Claims for implanted permanent cardiac pacemakers submitted before July 7 may be denied, and claims may need to be resubmitted.
UPDATE: CMS released MM8525 Revised July 10, 2014, delaying implementation until further notice.
Payment for implanted permanent cardiac pacemakers is contingent on documentation of nonreversible symptomatic bradycardia due to:

  1. Sinus node dysfunction
  2. Second- or third-degree atrioventricular block

Append modifier KX to the procedure code to indicate that documentation is on file verifying the patient has non-reversible symptomatic bradycardia (ICD-9: 427.89 Other specified cardiac dysrhythmias; ICD-10 Bradycardia, unspecified).
The telltale sign of bradycardia is a heart rate less than 60 beats per minute, which may cause one or more of the following symptoms:

  • Syncope (780.2)
  • Seizures (780.3)
  • Congestive heart failure (482.0)
  • Dizziness (780.4)
  • Confusion (298.2)

For proper code selection, documentation must indicate whether the right atrium or right ventricle was targeted (single-chamber pacemaker), or both (dual-chamber pacemaker).
CPT® codes:
33206         Insertion of new or replacement permanent pacemaker with transvenous electrode; atrial
33207                  ; ventricular
33208                  ; atrial and ventricular
Local anesthesia (CPT® 00530 Anesthesia for permanent transvenous pacemaker insertion) is generally used to perform the inpatient procedure.
For complete details, see Medicare NCD Manual, chapter 1, part 1, sec. 20.8.3.
Source: CMS transmittal 161, CR 8528, Feb. 6, 2013

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No Responses to “New Medicare Coverage for Pacemakers Used to Treat Bradycardia”

  1. Laurie McLeod says:

    Recently our internal med necessity edits starting editing generator changes for single and dual pacemakers. Does the KX modifier apply for generator changes as well or just the initial insertion of the device?

  2. Karren Smith says:

    Congestive Heart Failure should be 428.0

  3. Jennifer Wilson says:

    Please see the CMS billing instructions 8525 for the contractors. There appears to be several issues. This just appears to be one of them. It states the contractor’s shall deny IP and OP claims if submitted with 780.2. Even though it states syncope is a symptom. It also states 427.89 is a reason to deny.

  4. B. Miller says:

    Please see above comments (ICD9 code wrong and Jennifer Wilson’s note). They do seem to contradict themselves in their own policy. They indicate bradycardia needs to be established then say they will deny dual claims for having it. Same thing with the symptom, syncope.
    Also they seem to be saying that the doctor needs to document sinus node dysfunction or heart block plus symptoms of bradycardia. Are they expecting to see multiple ICD9 codes for this? One for the symptom, one for bradycardia one for the heart block or sinus node dysfunction?