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Medicare Compliance & Reimbursement

Hospitals:

Pacemaker Coverage Expands

Published on Thu Apr 22, 2004

CMS memo: "Pacemaker implantation is no longer an experimental procedure."

Good news for providers involved in pacemaker implantation procedures.

After years of pressure to reconsider its stance, the Centers for Medicare & Medicaid Services has finally succumbed, saying it intends to update cardiac pacemaker coverage for the first time since 1985.

The implantation of cardiac pacemakers is officially deemed to be a reasonable and necessary procedure -- no longer an experimental one -- with minimal risk and a time-tested technique, thereby meeting the requirements for Medicare coverage.

However, victory is limited. Whether the pacemaker itself is reasonable and necessary for certain medical conditions remains the subject of further study, and for now is up to the discretion of individual carriers.

"We are taking the...limited step of revising CIM 65-6 to make clear that the focus of the determination of whether cardiac pacing is reasonable and necessary is not the surgical implantation procedure itself, but instead is based on the medical indications that justify the use of cardiac pacing," the March 12 decision memorandum says.

Lesson Learned: Providers who perform cardiac pacemaker implantations can look forward to Medicare coverage in the not so distant future.

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