Billing Guidelines for Leadless Pacemakers

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Billing Guidelines for Leadless Pacemakers
NCD for Leadless Pacemakers The leadless
pacemaker eliminates the need for a device pocket
and insertion of a pacing lead which are integral
elements of traditional pacing systems. The
removal of these elements eliminates an important
source of complications associated with
traditional pacing systems while providing
similar benefits. Leadless pacemakers are
delivered via catheter to the heart, and function
similarly to other transvenous single-chamber
ventricular pacemakers. Billing guidelines have
been developed to help you understand Medicare
coverage, coding, and payment for Leadless
pacemakers procedures. Medicare has a National
Coverage Determination (NCD) designating coverage
for leadless pacemakers. Under the NCD, Medicare
covers leadless pacemakers through coverage with
evidence development (CED), which means CMS will
provide coverage for leadless pacemakers when
procedures are performed as part of an ongoing,
CMS-approved study and used according to the
FDA-labeled indications for the device. Medicare
NCDs apply to both traditional Medicare and
Medicare Advantage (MA) plans. Non-Medicare
payers typically determine coverage for
procedures based on prior authorization. We would
recommend reviewing the specific payer coverage
policies applicable to your patient to verify all
the criteria for coverage are met.
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Billing Guidelines for Leadless Pacemakers

• You must contact the payer to obtain prior
  authorization or prior approval. Asking about
  coverage after an implant procedure may result in
  unpaid claims, leaving both the hospital and the
  physician without compensation.
• Billing Guidelines
• The following CPT codes describe procedures
  associated with Leadless Pacemaker Therapy.
  Services rendered will dictate the appropriate
  coding. These codes may be used by physicians for
  all services and may be used by facilities when
  services are rendered in the outpatient hospital
  or ambulatory surgery center setting. It is the
  physicians discretion as to what codes to report
  based on what procedures were performed. Make
  sure that all diagnosis and procedure codes must
  be supported by clear documentation within the
  medical record.
• CPT Codes for Insertion or Removal of Leadless
  Pacemaker
• CPT 33274 Transcatheter insertion or replacement
  of permanent leadless pacemaker, right
  ventricular, including imaging guidance (e.g.,
  fluoroscopy, venous ultrasound, ventriculography,
  femoral venography) and device evaluation (e.g.,
  interrogation or programming), when performed.

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Billing Guidelines for Leadless Pacemakers

• CPT 33275 Transcatheter removal of a permanent
  leadless pacemaker, right ventricular, including
  imaging guidance (e.g., fluoroscopy, venous
  ultrasound, ventriculography, femoral
  ventriculography), when performed.
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• CPT is a registered trademark of the American
  Medical Association
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• Modifier to Category I CPT Implant Code
• Q0 Investigational clinical service provided in
  a clinical research study that is in an approved
  clinical research study.
• Diagnosis Code
• 6 Encounter for examination for normal
  comparison and control in a clinical research
  program
• Place of Service Code
• 06 Indian Health Service Provider Based Facility
• 21 Inpatient Hospital

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Billing Guidelines for Leadless Pacemakers

• 22 On Campus-Outpatient Hospital
• 26 Military Treatment Facility
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• Cardiology is tough and encompasses new
  techniques and technologies every now and then.
  Therefore, its medical billing services require
  special understanding to adapt to changes in the
  reporting requirements. An important thing to
  maximize revenue for cardiologists is
  that outsourced cardiology billing services drive
  abstract physician operational notes.
•  
• We are having a team of HIPAA-compliant experts
  with a clean claim submission rate of 98. Get in
  touch with our experts specializing in cardiology
  billing and coding.