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Claim Payment Policy

Title:

Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)

Policy #:

03.02.13f

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.

Policy

When an evaluation or setup of a cardiac pacemaker is reported with an electrocardiogram (ECG/EKG), the ECG/EKG is considered to be integral or inherent to the pacemaker evaluation and is, therefore, not eligible for reimbursement consideration.

Guidelines

This claim payment rationale applies only to the applicable code combinations addressed in this policy and does not apply to any other code and/or code and modifier combinations. Claims are processed according to the statements in this policy. When a medical policy on this topic also exists, the medical necessity criteria listed in the medical policy must be met.

The table below depicts the claims processing outcome when a cardiac pacemaker evaluation or setup code (column 1) is reported with an electrocardiographic (ECG/EKG) code (column 2). This table is a complete list of applicable codes.

WHEN ANY OF THE CODES IN COLUMN 1 ARE REPORTED WITH ANY OF THE CODES IN COLUMN 2, THE CODES IN COLUMN 1 ARE ELIGIBLE FOR REIMBURSEMENT CONSIDERATION AND THE CODES IN COLUMN 2 ARE DENIED
COLUMN 1 CARDIAC PACEMAKER EVALUATION OR SETUP PROCEDURE CODES	COLUMN 2 ECG/EKG PROCEDURE CODES	OUTCOME
93279, 93280, 93281, 93282, 93283, 93284, 93286, 93287, 93288, 93289, 93293, 93294, 93295, 93296, 93640, 93641, 93642, 93724, 93745	93000, 93005, 93010, 93040, 93041, 93042	93279, 93280, 93281, 93282, 93283, 93284, 93286, 93287, 93288, 93289, 93293, 93294, 93295, 93296, 93640, 93641, 93642, 93724, 93745 are processed as eligible for reimbursement consideration. 93000, 93005, 93010, 93040, 93041, 93042 are denied for reimbursement consideration as inherent to the pacemaker evaluation or setup.

The inclusion of codes in this policy does not imply coverage or reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and applicable policies apply

MEDICARE

This policy is consistent with Medicare Correct Coding Initiative (CCI) edits.

Description

A cardiac pacemaker is a self-contained, battery-operated unit that sends electrical stimulation to the heart to normalize cardiac rhythm. Pacemaker evaluation may include an assessment of the rate, pulse amplitude and duration, configuration of waveform, and/or sensory function of the pacemaker, as well as telephonic analysis, electrocardiograms, and the physician's interpretation of the findings.

An electrocardiogram (ECG/EKG) is a test that records the electrical activity of the heart. It measures the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any heart damage, and the effects of any drugs or devices used to regulate the heart (e.g., pacemaker).

References

Centers for Medicare and Medicaid Services (CMS). Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.8.1 - Cardiac Pacemaker Evaluation Services. [CMS website]. 04/03/18. Available at:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part1.pdf. Accessed October 3, 2018.

Centers for Medicare and Medicaid Services (CMS). Medicare National Coverage Determinations Manual, Chapter 1, Part 1, Section 20.15 - Electrocardiographic Services. [CMS website]. 04/03/18. Available at:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part1.pdf. Accessed October 3, 2018.

Centers for Medicare and Medicaid Services (CMS). Decision Memo for Cardiac Pacemakers: Single-Chamber and Dual-Chamber Permanent Cardiac Pacemakers (CAG-00063R3). [CMS website]. 08/13/13. Available at:
https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=267. Accessed October 3, 2018.

Centers for Medicare and Medicaid Services (CMS). Local Coverage Determination (LCD). L34087: Surveillance of Implantable or Wearable Cardioverter Defribrillators (ICDs): Office, Hospital, Web, or Non-Web Based. [CMS Website]. 10/01/2015. Available at:
https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34087&ver=9&Cntrctr=All&UpdatePeriod=795&bc=AQAAEAAAAAAA&. Accessed October 3, 2018.

National Institutes of Health. Medical Encyclopedia. Pacemaker. [MedlinePlus website]. 02/22/18. Available at:
https://medlineplus.gov/ency/imagepages/19566.htm. Accessed October 3, 2018.

US Food and Drug Administration (FDA). CFR- Code of Federal Regulations, Title 21 -- Food and Drugs, Chapter I -- Food and Drug Administration, Department of Health and Human Services, Subchapter H -- Medical Devices, Part 870 -- Cardiovascular Devices, Subpart D -- Cardiovascular Prosthetic Devices, Sec. 870.3680 Cardiovascular permanent or temporary pacemaker electrode. [FDA Website]. 09/04/2018. Available at:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=870.3680. Accessed October 3, 2018.

US Food and Drug Administration (FDA). Product Classification. Pulse Generator, Pacemaker, Implantable, With Cardiac Resynchronization (Crt-P). [FDA Website]. 10/01/2018. Available at:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=NKE. Accessed October 3, 2018.

Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

TO REPORT ELECTROCARDIOGRAM (ECG/EKG), USE THE FOLLOWING CODES

93000, 93005, 93010, 93040, 93041, 93042

TO REPORT PACEMAKER EVALUATION OR SETUP, USE THE FOLLOWING CODES
93279, 93280, 93281, 93282, 93283, 93284, 93286, 93287, 93288, 93289, 93293, 93294, 93295, 93296, 93640, 93641, 93642, 93724, 93745

Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.

ICD-10 Procedure Code Number(s)

N/A

ICD-10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

N/A

Revenue Code Number(s)

N/A

Policy History

REVISIONS FROM 03.02.13f

01/01/2019

This policy has been identified and updated for the CPT code update effective 01/01/2019.

The following CPT narratives have been revised in this policy:

93279

FROM: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system

TO: Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system or leadless pacemaker system in one cardiac chamber

93286

FROM: Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system

TO: Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review and report by a physician or other qualified health care professional; single, dual, or multiple lead pacemaker system, or leadless pacemaker system

93288

FROM: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system

TO: Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system, or leadless pacemaker system

93294

FROM: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

TO: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional

93296

FROM: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

TO: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results

REVISIONS FROM 03.02.13e

11/21/2018

This policy became effective 01/01/2015. It has been reviewed and reissued to communicate the Company’s continuing position on evaluation or setup of a cardiac pacemaker reported with an electrocardiogram (ECG/EKG).

Effective 10/05/2017 this policy has been updated to the new policy template format.

	Version Effective Date: 01/01/2019
	Version Issued Date: 01/03/2019
	Version Reissued Date: N/A