Check Your Automatic External Defibrillator LCD

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  • In CMS
  • February 15, 2010
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Beware of marketing material suggesting coverage for a wearable automatic external defibrillator (AED) is available immediately following a myocardial infarction and in several clinical situations. If it is not specified as such in your contractor’s Local Coverage Determination (LCD), it is not covered, warns Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

AEDs reported with HCPCS Level II code K0606 Automatic external defibrillator, with integrated electrocardiogram analysis, garment type are covered as an alternative to implanted defibrillators only when criteria specified in the LCD for Automatic External Defibrillators are met.
Wearable AEDs are covered for patients if they meet one of the following criteria:

  1. A documented episode of ventricular fibrillation or a sustained, lasting 30 seconds or longer, ventricular tachyarrhythmia. These dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study, but may not be due to a transient or reversible cause and not occur during the first 48 hours of an acute myocardial infarction (ICD-9 427.1, 427.42, 427.5); or

  2. Familial or inherited conditions with a high risk of life-threatening ventricular tachyarrhythmia, such as long QT syndrome (ICD-9 426.82) or hypertrophic cardiomyopathy (ICD-9 425.1); or

  3. Either documented prior myocardial infarction (ICD-9 410.00-410.92, 412) or dilated cardiomyopathy (ICD-9 425.0-425.9) and a measured left ventricular ejection fraction less than or equal to 0.35; or

  4. A previously implanted defibrillator now requires explantation (ICD-9 996.04, 996.61)

Nonwearable AEDs (E0617 External defibrillator with integrated electrocardiogram analysis) have different coverage criteria.
Refer to the NHIC, Corp. LCD for Automatic External Defibrillators (L13616) for additional information.

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