NCD for Leadless Pacemakers
The leadless pacemaker eliminates the need for a device pocket and insertion of a pacing lead which are integral elements of traditional pacing systems. The removal of these elements eliminates an important source of complications associated with traditional pacing systems while providing similar benefits. Leadless pacemakers are delivered via catheter to the heart, and function similarly to other transvenous single-chamber ventricular pacemakers. Billing guidelines have been developed to help you understand Medicare coverage, coding, and payment for Leadless pacemaker’s procedures.
Medicare has a National Coverage Determination (NCD) designating coverage for leadless pacemakers. Under the NCD, Medicare covers leadless pacemakers through coverage with evidence development (CED), which means CMS will provide coverage for leadless pacemakers when procedures are performed as part of an ongoing, CMS-approved study and used according to the FDA-labeled indications for the device.
Medicare NCDs apply to both traditional Medicare and Medicare Advantage (MA) plans. Non-Medicare payers typically determine coverage for procedures based on prior authorization. We would recommend reviewing the specific payer coverage policies applicable to your patient to verify all the criteria for coverage are met. You must contact the payer to obtain prior authorization or prior approval. Asking about coverage after an implant procedure may result in unpaid claims, leaving both the hospital and the physician without compensation.
The following CPT® codes describe procedures associated with Leadless Pacemaker Therapy. Services rendered will dictate the appropriate coding. These codes may be used by physicians for all services and may be used by facilities when services are rendered in the outpatient hospital or ambulatory surgery center setting. It is the physician’s discretion as to what codes to report based on what procedures were performed. Make sure that all diagnosis and procedure codes must be supported by clear documentation within the medical record.
CPT Codes for Insertion or Removal of Leadless Pacemaker
- CPT 33274: Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (e.g., interrogation or programming), when performed.
- CPT 33275: Transcatheter removal of a permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral ventriculography), when performed.
CPT® is a registered trademark of the American Medical Association
Modifier to Category I CPT® Implant Code
- Q0: Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
- 6: Encounter for examination for normal comparison and control in a clinical research program
Place of Service Code
- 06: Indian Health Service Provider Based Facility
- 21: Inpatient Hospital
- 22: On Campus-Outpatient Hospital
- 26: Military Treatment Facility
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