March 16, 2023

Cardiac pacemaker coverage

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

Billing requirements

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.


  • 33206
  • 33207
  • 33208

ICD-10-CM diagnostic codes: 

     Group 1

  • I44.1I44.2I49.5
  • Q24.6

The following diagnosis codes may be covered if submitted with at least 1 of the CPT codes and diagnosis codes listed above.

     Group 2

  • G90.01
  • I44.0
  • I44.30
  • I44.39
  • I44.7
  • I45.10
  • I45.19


  • I45.2
  • I45.3
  • I47.1
  • I47.9
  • I48.0
  • I48.11
  • I48.19


  • I48.20
  • I48.21
  • I48.3
  • I48.4
  • I48.91
  • I48.92


Please contact your provider advocate or visit our Contact Us page for more information.

CPT® is a registered trademark of the American Medical Association.
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