Medicare Compliance & Reimbursement

Coverage:

ICD COVERAGE EXPANDS- BUT ONLY SLIGHTLY

Health care 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.

The Centers for Medicare & Medicaid Services announced June 6 that it will be adding the following two indications to Medicare coverage:

  • 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.

    Those types of cases represent only a portion of patients studied in the Multicenter Auto

    matic Defibrillator Implantation Trial II. Device manufacturers Guidant Corp. and Medtronic Inc. had hoped CMS would agree to cover a much larger population.

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