The Centers for Medicare & Medicaid Services (CMS) initiated a national determination coverage decision July 7 for permanent cardiac pacemakers that will require a modifier to receive Medicare reimbursement for procedures.
In 2013, CMS ruled in favor of single- and dual-chamber pacemakers as a treatment for nonreversible symptomatic bradycardia due to sinus node dysfunction and second- or third-degree atrioventricular block. Medicare will begin paying professional claims for implanted pacemakers that have proper CPT codes plus submission of a KX modifier “as attestation by the practitioner and/or provider of the service that documentation is on file verifying the patient has non-reversible symptomatic bradycardia.”
Medicare administrative contractors will return claims if the KX modifier is missing. CMS provided more information on pacemaker billing and coding here.