Part B Insider (Multispecialty) Coding Alert
ICD COVERAGE EXPANDS - BUT ONLY SLIGHTLY
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Healthcare providers will soon be able to bill Medicare for implantable cardioverter defibrillators in more circumstances. But the extent of the ICD coverage expansion is not as broad as many had hoped.
patients with coronary artery disease with prior myocardial infarction, left ventricular ejection fraction of less than or equal to 0.35, and inducible, sustained ventricular tachycardia or ventricular fibrillation at electrophysiological study; and
patients with a prior heart attack and left ventricular ejection fraction of less than or equal to 0.30, and an electrical conduction abnormality in the heart, duration of greater than 120 milliseconds.
The Centers for Medicare & Medicaid Services announced June 6 that it will be adding the following two indications to Medicare coverage:
Those types of cases represent only a portion of patients studied in the Multicenter Automatic Defibrillator Implantation Trial II. Device manufacturers Guidant Corp. and Medtronic Inc. had hoped CMS would agree to cover a much larger population.
Broader coverage of ICDs may be in the offing, as CMS has promised to revisit the issue early next year.
Part B Insider (Multispecialty) Coding Alert
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