Pacemaker coverage finalized

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 - electrophysiology, ICD, pacemaker

The Centers for Medicare & Medicaid Services (CMS) has  finalized its proposal to eliminate the distinction in coverage criteria between single- and dual-chamber devices.

Either therapy will be covered for "documented symptomatic bradycardia" due to sinus node dysfunction, second degree atrioventricular block, and/or third degree atriventricular block. A number of other indications will be non-covered. Medicare Administrative Contractors continue to hold the authority to determine coverage for other indications not addressed in the national coverage determination.

The American College of Cardiology (ACC) collaborated with the Heart Rhythm Society to  request coverage updates and then to  recommend revisions to the coverage CMS initially proposed. After initially proposing noncoverage, CMS will permit local contractors to determine coverage for prophylactic pacemaker use following myocardial infarction and hypersensitive carotid sinus syndrome. Thorough documentation of the need for dual-chamber pacemakers continues to be required.

The policy is effective as of publication on Aug. 13.