Determination guidelines and billing requirements for Medicare Advantage members
The following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers per the Centers for Medicare & Medicaid Services (CMS) National Coverage Determination Guidelines:
Documented non-reversible symptomatic bradycardia due to sinus node dysfunction
Documented non-reversible symptomatic bradycardia due to second-degree and/or third-degree atrioventricular block
UnitedHealthcare will pay outpatient institutional claims for implanted permanent cardiac pacemakers, single chamber or dual chamber, provided the claim contains the KX modifier, and contains at least 1 of the following CPT® codes and 1 of the following ICD-10-CM diagnostic codes.
ICD-10-CM diagnostic codes:
The following diagnosis codes may be covered if submitted with at least 1 of the CPT codes and diagnosis codes listed above.
Please contact your provider advocate or visit our Contact Us page for more information.
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