Cardiac Pacemaker - Medicare allowed frequency

MEDICARE’S FREQUENCY GUIDELINES FOR TRANSTELEPHONIC MONITORING OF CARDIAC PACEMAKERS


Guideline I

Single-chamber pacemakers:

»» 1st month: every 2 weeks

»» 2nd through 36th month: every 8 weeks

»» 37th month to failure: every 4 weeks

Dual-chamber pacemakers: 1st month: every 2 weeks

»» 2nd through 6th month: every 4 weeks

»» 7th through 36th month: every 8 weeks

»» 37th month to failure: every 4 weeks

Guideline II

Single-chamber pacemakers:

13. 1st month: every 2 weeks

14. 2nd through 48th month: every 12 weeks

15. 49th through 72nd month: every 8 weeks

16. Thereafter: every 4 weeks


Dual-chamber pacemakers:

»» 1st month: every 2 weeks

»» 2nd through 30th month: every 12 weeks

»» 31st through 48th month: every 8 weeks

»» Thereafter: every 4 weeks


D. Pacemaker Clinic Services

General

Pacemaker monitoring is also covered when done by pacemaker clinics. Clinic visits may be done in conjunction with transtelephonic
monitoring or as a separate service; however, the services rendered by a pacemaker clinic are more extensive than those currently
possible by telephone. They include, for example, physical examination of patients and reprogramming of pacemakers. Thus, the use of
one of these types of monitoring does not preclude concurrent use of the other.

Frequency Guidelines

As with transtelephonic pacemaker monitoring, the frequency of clinic visits is the decision of the patient’s physician taking into account, among other things, the medical condition of the patient. However, contractors can develop monitoring guidelines that will prove useful in screening claims. The following are recommendations for monitoring guidelines on lithium-battery pacemakers:


MEDICARE’S FREQUENCY GUIDELINES FOR PACEMAKER CLINIC SERVICES

»» For single-chamber pacemakers: twice in the first 6 months following implant, then once every 12 months

»» For dual-chamber pacemakers: twice in the first 6 months, then once every 6 months


Pacemaker – Temporary

At this time there is no specific Medicare National Coverage Determination (NCD) for temporary pacemakers. It is important for medical providers to check with their local MAC or non-Medicare payer(s) to determine patient coverage and coding/billing guidelines.

Note: Search the Medicare Coverage Database on the CMS website (http://www.cms.hhs.gov/mcd/search.asp) for coverage descriptions and updates.