URL for source document:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56342&ver=24&bc=0
Article Title

Billing and Coding: Implantable Automatic Defibrillators

Article Type

Billing and Coding

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights
Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the
AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or
indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or
not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No
portion of the American Hospital Association (AHA) copyrighted materials contained within this publication
may be copied without the express written consent of the AHA. AHA copyrighted materials including the
UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service,
solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA
materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for
internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative
work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04
Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express
license from the American Hospital Association. The American Hospital Association (the "AHA") has not
reviewed, and is not responsible for, the completeness or accuracy of any information contained in this
material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis
of information provided in the material. The views and/or positions presented in the material do not
necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA
or any of its affiliates.

1
CMS National Coverage Policy

N/A

Article Guidance

Article Text

The National Coverage Determination (NCD) 20.4, Implantable Automatic Defibrillators was revised with an
effective date of February 15, 2018. The CMS A/B Medicare Administrative Contractors (MACs) have been
instructed to implement the NCD at the local level. The following provides coding and billing instructions for
the implementation of NCD 20.4. (CMS policy language is in italics.) The NCD “Item/Service Description”
and “Indications and Limitations” are repeated here.

This article does not alter previous CMS A/B Medicare Administrative Contractors (MACs) instructions for
coding and billing of NCD 20.8.3 (National Coverage Determination (NCD) for Cardiac Pacemakers: Single
Chamber and Dual Chamber Permanent Cardiac Pacemakers) nor does it alter MAC Local Coverage for
Cardiac Resynchronization Therapy.

Item/Service Description

A. General An ICD is an electronic device designed to diagnose and treat life-threatening ventricular
tachyarrhythmias.

Indications and Limitations of Coverage

B. Nationally Covered Indications

Effective for services performed on or after February 15, 2018, CMS has determined that the evidence is
sufficient to conclude that the use of ICDs, (also referred to as defibrillators) is reasonable and necessary:

1. Patients with a personal history of sustained Ventricular Tachyarrhythmia (VT) or cardiac arrest due to
Ventricular Fibrillation (VF). Patients must have demonstrated:

2
An episode of sustained VT, either spontaneous or induced by an Electrophysiology (EP) study, not
associated with an acute Myocardial Infarction (MI) and not due to a transient or reversible cause; or

An episode of cardiac arrest due to VF, not due to a transient or reversible cause.

ICD-10-CM codes which describe the above: I46.2, I46.9, I47.2, I49.01, I49.02, I49.3, I49.9, I5A, Z45.02 or
Z86.74.

2. Patients with a prior MI and a measured Left Ventricular Ejection Fraction (LVEF) ≤ 0.30. Patients must
not have:

New York Heart Association (NYHA) classification IV heart failure; or,

Had a Coronary Artery Bypass Graft (CABG), or Percutaneous Coronary Intervention (PCI) with angioplasty
and/or stenting, within the past three (3) months; or,

Had an MI within the past 40 days; or,

Clinical symptoms and findings that would make them a candidate for coronary revascularization.

For these patients identified in B2, a formal shared decision making encounter must occur between the patient
and a physician (as defined in Section 1861(r)(1) of the Social Security Act (the Act)) or qualified
non-physician practitioner (meaning a physician assistant, nurse practitioner, or clinical nurse specialist as
defined in §1861(aa)(5) of the Act) using an evidence-based decision tool on ICDs prior to initial ICD
implantation. The shared-decision making encounter may occur at a separate visit.

ICD-10-CM code I25.2 must be billed with one of the following ICD-10-CM codes which describe the above:
I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

3. Patients who have severe, ischemic, dilated cardiomyopathy but no personal history of sustained VT or
cardiac arrest due to VF, and have NYHA Class II or III heart failure, LVEF ≤ 35%. Additionally, patients
must not have:

Had a CABG, or PCI with angioplasty and/or stenting, within the past three (3) months; or,

Had an MI within the past 40 days; or,

Clinical symptoms and findings that would make them a candidate for coronary revascularization.

For these patients identified in B3, a formal shared decision making encounter must occur between the patient
and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning

3
a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act)
using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared decision-making
encounter may occur at a separate visit.

ICD-10-CM code I25.5 must be billed with one of the following ICD-10-CM codes which describe the above:
I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

4. Patients who have severe, non-ischemic, dilated cardiomyopathy but no personal history of cardiac arrest or
sustained VT, NYHA Class II or III heart failure, LVEF ≤ 35%, been on optimal medical therapy for at least
three (3) months. Additionally, patients must not have:

Had a CABG or PCI with angioplasty and/or stenting, within the past three (3) months; or,

Had an MI within the past 40 days; or,

Clinical symptoms and findings that would make them a candidate for coronary revascularization.

For these patients identified in B4, a formal shared decision making encounter must occur between the patient
and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning
a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act)
using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared-decision making
encounter may occur at a separate visit.

ICD-10-CM codes I42.0, I42.6, I42.7 or I42.8 must be billed with one of the following ICD-10-CM codes
which describe the above: I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43.

5. Patients with documented, familial or genetic disorders with a high risk of life-threatening tachyarrhythmias
(sustained VT or VF, to include, but not limited to, long QT syndrome or hypertrophic cardiomyopathy).

For these patients identified in B5, a formal shared decision making encounter must occur between the patient
and a physician (as defined in Section 1861(r)(1) of the Act) or qualified non-physician practitioner (meaning
a physician assistant, nurse practitioner, or clinical nurse specialist as defined in §1861(aa)(5) of the Act)
using an evidence-based decision tool on ICDs prior to initial ICD implantation. The shared decision-making
encounter may occur at a separate visit.

ICD-10-CM codes which describe the above: I42.1, I42.2, I45.6, I45.81 or I45.89.

4
6. Patients with an existing ICD may receive an ICD replacement if it is required due to the end of battery life,
Elective Replacement Indicator (ERI), or device/lead malfunction.

For each of the six (6) covered indications above, the following additional criteria must also be met:

Patients must be clinically stable (e.g., not in shock, from any etiology);

LVEF must be measured by echocardiography, radionuclide (nuclear medicine) imaging, cardiac Magnetic
Resonance Imaging (MRI), or catheter angiography;

Patients must not have:

Significant, irreversible brain damage; or,

Any disease, other than cardiac disease (e.g., cancer, renal failure, liver failure) associated with a likelihood of
survival less than one (1) year; or,

Supraventricular tachycardia such as atrial fibrillation with a poorly controlled ventricular rate.

Exceptions to waiting periods for patients that have had a CABG, or PCI with angioplasty and/or stenting,
within the past three (3) months, or had an MI within the past 40 days:

Cardiac Pacemakers: Patients who meet all CMS coverage requirements for cardiac pacemakers, and who
meet the criteria in NCD 20.4 for an ICD, may receive the combined devices in one procedure, at the time the
pacemaker is clinically indicated;

Replacement of ICDs: Patients with an existing ICD may receive an ICD replacement if it is required due to
the end of battery life, ERI, or device/lead malfunction.

ICD-10-CM codes which describe the above: T82.110A, T82.111A, T82.118A, T82.119A, T82.120A,
T82.121A, T82.128A, T82.129A, T82.190A, T82.191A, T82.198A, T82.199A, T82.7XXA or Z45.02.

C. Nationally Non-Covered Indications

N/A

5
D. Other

For patients that are candidates for heart transplantation on the United Network for Organ Sharing (UNOS)
transplant list awaiting a donor heart, coverage of ICDs, as with cardiac resynchronization therapy, as a
bridge-to-transplant to prolong survival until a donor becomes available, is determined by the local Medicare
Administrative Contractors (MACs).

ICD-10-CM code Z76.82 must be billed with ICD-10-CM code I50.84 which describes the above.

All other indications for ICDs not currently covered in accordance with this decision may be covered under
Category B Investigational Device Exemption (IDE) trials (42 CFR 405.201).

ICD-10-CM code which describes the above: Z00.6.

NOTE: Effective February 15, 2018, coverage policy is no longer contingent on participation in a
trial/study/registry. Therefore, claims with DOS on an after February 15, 2018, no longer require trial-related
coding unless they are associated with a Category B IDE trial, in which case Z00.6 must be appended to the
claim.

The coding and billing guidelines apply to the following ICD-10-Procedure codes: insertion codes: 0JH608Z,
0JH609Z, 0JH638Z, 0JH639Z, 0JH808Z, 0JH809Z, 0JH838Z, 0JH839Z, 0JH60FZ, 0JH63FZ, 02H43KZ,
02H60KZ, 02H63KZ, 02H64KZ, 02H70KZ, 02H73KZ, 02H74KZ, 02HK0KZ, 02HK3KZ, 02HK4KZ,
02HL0KZ, 02HL3KZ, 02HL4KZ and removal codes: 0JPT0FZ, 0JPT3FZ, 0JPT0PZ, 0JPT3PZ, 02PA0MZ,
02PA3MZ, 02PA4MZ and 02PAXMZ.

The coding and billing guidelines also apply to the following CPT codes: 33202, 33203, 33223, 33230,
33231, 33240, 33241, 33243, 33244, 33249, 33262, 33263, 33264, 33270, 33271, 33272, 33273, G0448,
33215, 33216, 33217, 33218, 33220, 33224, 33225, C7537, C7538, C7539 and C7540.

Coding Information

CPT/HCPCS Codes

6
Expand All | Collapse All

Group 1 (29 Codes)

Group 1 Paragraph

N/A

Group 1 Codes

Code Description

33202 INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY,

MEDIAN STERNOTOMY, SUBXIPHOID APPROACH)

33203 INSERTION OF EPICARDIAL ELECTRODE(S); ENDOSCOPIC APPROACH (EG,

THORACOSCOPY, PERICARDIOSCOPY)

33215 REPOSITIONING OF PREVIOUSLY IMPLANTED TRANSVENOUS PACEMAKER OR

IMPLANTABLE DEFIBRILLATOR (RIGHT ATRIAL OR RIGHT VENTRICULAR) ELECTRODE

33216 INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR

IMPLANTABLE DEFIBRILLATOR

33217 INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR

IMPLANTABLE DEFIBRILLATOR

33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR

IMPLANTABLE DEFIBRILLATOR

33220 REPAIR OF 2 TRANSVENOUS ELECTRODES FOR PERMANENT PACEMAKER OR

IMPLANTABLE DEFIBRILLATOR

33223 RELOCATION OF SKIN POCKET FOR IMPLANTABLE DEFIBRILLATOR

33224 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT

VENTRICULAR PACING, WITH ATTACHMENT TO PREVIOUSLY PLACED PACEMAKER OR
IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR (INCLUDING REVISION OF POCKET,
REMOVAL, INSERTION, AND/OR REPLACEMENT OF EXISTING GENERATOR)

33225 INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT

VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE DEFIBRILLATOR OR
PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMBER SYSTEM) (LIST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

33230 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH

EXISTING DUAL LEADS

7
33231 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH
EXISTING MULTIPLE LEADS

33240 INSERTION OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY; WITH

EXISTING SINGLE LEAD

33241 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY

33243 REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR

ELECTRODE(S); BY THORACOTOMY

33244 REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR

ELECTRODE(S); BY TRANSVENOUS EXTRACTION

33249 INSERTION OR REPLACEMENT OF PERMANENT IMPLANTABLE DEFIBRILLATOR

SYSTEM, WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER

33262 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH

REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; SINGLE LEAD
SYSTEM

33263 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH

REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; DUAL LEAD SYSTEM

33264 REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH

REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; MULTIPLE LEAD
SYSTEM

33270 INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE

DEFIBRILLATOR SYSTEM, WITH SUBCUTANEOUS ELECTRODE, INCLUDING DEFIBRILLATION
THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR
ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR
THERAPEUTIC PARAMETERS, WHEN PERFORMED

33271 INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE

33272 REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE

33273 REPOSITIONING OF PREVIOUSLY IMPLANTED SUBCUTANEOUS IMPLANTABLE

DEFIBRILLATOR ELECTRODE

C7537 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH ATRIAL

TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS
SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF IMPLANTABLE
DEBRIBRILLATOR OR PACEMAKE PULSE GENERATOR (EG, FOR UPGRADE TO DUAL
CHAMBER SYSTEM)

C7538 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH

VENTRICULAR TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING ELECTRODE,
CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF
IMPLANTABLE DEFRIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE

8
TO DUAL CHAMBER SYSTEM)

C7539 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH ATRIAL

AND VENTRICULAR TRANSVENOUS ELECTRODE(S), WITH INSERTION OF PACING
ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF
INSERTION OF IMPLANTABLE DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR
UPGRADE TO DUAL CHAMBER SYSTEM)

C7540 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT

OF PACEMAKER PULSE GENERATOR, DUAL LEAD SYSTEM, WITH INSERTION OF PACING
ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF
INSERTION OF IMPLANTABLE DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR
UPGRADE TO DUAL CHAMBER SYSTEM)

G0448 INSERTION OR REPLACEMENT OF A PERMANENT PACING

CARDIOVERTER-DEFIBRILLATOR SYSTEM WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL
CHAMBER WITH INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT
VENTRICULAR PACING

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Expand All | Collapse All

Group 1 (45 Codes)

Group 1 Paragraph

For inpatient and outpatient institutional claims ICD-10-CM codes I25.2, I25.5, I42.0, I42.6, I42.7, I42.8 and
Z76.82 must be reported with a secondary diagnosis as described in the Article Text above.

Group 1 Codes

Code Description

I25.2 Old myocardial infarction

I25.5 Ischemic cardiomyopathy

I42.0 Dilated cardiomyopathy

I42.1 Obstructive hypertrophic cardiomyopathy

I42.2 Other hypertrophic cardiomyopathy

I42.6 Alcoholic cardiomyopathy

9
I42.7 Cardiomyopathy due to drug and external agent

I42.8 Other cardiomyopathies

I45.6 Pre-excitation syndrome

I45.81 Long QT syndrome

I45.89 Other specified conduction disorders

I46.2 Cardiac arrest due to underlying cardiac condition

I46.9 Cardiac arrest, cause unspecified

I47.20 Ventricular tachycardia, unspecified

I47.21 Torsades de pointes

I47.29 Other ventricular tachycardia

I49.01 Ventricular fibrillation

I49.02 Ventricular flutter

I49.3 Ventricular premature depolarization

I49.9 Cardiac arrhythmia, unspecified

I50.21 Acute systolic (congestive) heart failure

I50.22 Chronic systolic (congestive) heart failure

I50.23 Acute on chronic systolic (congestive) heart failure

I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure

I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.84 End stage heart failure

I5A Non-ischemic myocardial injury (non-traumatic)

T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter

T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter

T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter

T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter

10
T82.120A Displacement of cardiac electrode, initial encounter

T82.121A Displacement of cardiac pulse generator (battery), initial encounter

T82.128A Displacement of other cardiac electronic device, initial encounter

T82.129A Displacement of unspecified cardiac electronic device, initial encounter

T82.190A Other mechanical complication of cardiac electrode, initial encounter

T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter

T82.198A Other mechanical complication of other cardiac electronic device, initial encounter

T82.199A Other mechanical complication of unspecified cardiac device, initial encounter

T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants
and grafts, initial encounter

Z00.6 Encounter for examination for normal comparison and control in clinical research program

Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator

Z76.82 Awaiting organ transplant status

Z86.74 Personal history of sudden cardiac arrest

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

Expand All | Collapse All

Group 1 (30 Codes)

Group 1 Paragraph

The following ICD-10 PCS Codes include both the Part A insertion and removal procedure codes.

Procedure code 02PAXMZ remains valid until 9/30/2021. This code will not be valid for dates of service
October1, 2021 and forward.

Group 1 Codes

Code Description

11
02H43KZ Insertion of Defibrillator Lead into Coronary Vein, Percutaneous Approach

02H60KZ Insertion of Defibrillator Lead into Right Atrium, Open Approach

02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach

02H64KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Endoscopic Approach

02H70KZ Insertion of Defibrillator Lead into Left Atrium, Open Approach

02H73KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Approach

02H74KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Endoscopic Approach

02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach

02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach

02HK4KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Endoscopic Approach

02HL0KZ Insertion of Defibrillator Lead into Left Ventricle, Open Approach

02HL3KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Approach

02HL4KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Endoscopic Approach

02PA0MZ Removal of Cardiac Lead from Heart, Open Approach

02PA3MZ Removal of Cardiac Lead from Heart, Percutaneous Approach

02PA4MZ Removal of Cardiac Lead from Heart, Percutaneous Endoscopic Approach

0JH608Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Open
Approach

0JH609Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest

Subcutaneous Tissue and Fascia, Open Approach

0JH60FZ Insertion of Subcutaneous Defibrillator Lead into Chest Subcutaneous Tissue and Fascia,
Open Approach

0JH638Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia,
Percutaneous Approach

0JH639Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Chest

Subcutaneous Tissue and Fascia, Percutaneous Approach

0JH63FZ Insertion of Subcutaneous Defibrillator Lead into Chest Subcutaneous Tissue and Fascia,
Percutaneous Approach

12
0JH808Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Open
Approach

0JH809Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen

Subcutaneous Tissue and Fascia, Open Approach

0JH838Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia,
Percutaneous Approach

0JH839Z Insertion of Cardiac Resynchronization Defibrillator Pulse Generator into Abdomen

Subcutaneous Tissue and Fascia, Percutaneous Approach

0JPT0FZ Removal of Subcutaneous Defibrillator Lead from Trunk Subcutaneous Tissue and Fascia, Open
Approach

0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia,
Open Approach

0JPT3FZ Removal of Subcutaneous Defibrillator Lead from Trunk Subcutaneous Tissue and Fascia,
Percutaneous Approach

0JPT3PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia,
Percutaneous Approach

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this
service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete
absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be
assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to
report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article,
services reported under other Revenue Codes are equally subject to this coverage determination. Complete
absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article
should be assumed to apply equally to all Revenue Codes.

N/A

13
Other Coding Information

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation

01/01/2023 R8

Article text updated to add HCPCS codes C7537, C7538, C7539 and C7540 were added under section D.

01/01/2023 R7

Per Annual CPT/HPCPS Update, effective 01/01/2023 HCPCS codes C7537, C7538, C7539 and C7540 were
added to Group 1.

10/01/2022 R6

Per ICD-10 Annual Update effective 10/01/2022, I47.2 was deleted & replaced with 147.20, I47.21 & I47.29.

10/01/2021 R5

Add diagnosis code I5A to number 1 of the Nationally Covered Indications in the Article Text and the Group
1 ICD-10 diagnosis codes effective 10/01/2021 per CR12480.

The end date for ICD-10-PCS code 02PAXMZ is 09/30/2021 instead of 10/31/2021 stated in Revision History
number 4 below.

10/01/2019 R4

Added a hyphen between decision and making throughout the Article Text and the statement “NOTE:
Effective February 15, 2018, coverage policy is no longer contingent on participation in a trial/study/registry.
Therefore, claims with DOS on an after February 15, 2018, no longer require trial-related coding” to the
Article Text. Clarified the statement in Paragraph 1 in the ICD-10 Codes that Support Medical Necessity
section to indicate the diagnosis codes are for both inpatient and outpatient services and that the applicable
secondary diagnoses for the codes listed are listed in the Article Text. Added the ICD-10-PCS insertion and
removal codes in the ICD-10-PCS Codes Section and noted the removal code 02PAXMZ is valid until
10/31/2021.

14
10/01/2019 R3

Added the generator removal codes 0JPT0PZ and 0JPT3PZ to the Article Text that were erroneously deleted
with the previous update.

10/01/2019 R2

Article converted to Billing and Coding, no changes in coverage were made.

10/01/2019 R1

Changed the title to Billing and Coding: Implantable Automatic Defibrillators. Effective 10/01/2019, added
the ICD-10-PCS insertion codes 0JH60FZ and 0JH63FZ and removal codes 0JPT0FZ and 0JPT3FZ per the
annual ICD-10 updates.

Associated Documents

Related Local Coverage Documents

N/A

Related National Coverage Documents

N/A

Statutory Requirements URLs

N/A

Rules and Regulations URLs

N/A

CMS Manual Explanations URLs

National Coverage Determination (NCD) for Implantable Automatic Defibrillators (20.4)

Other URLs

N/A

Public Versions

Updated On Effective Dates Status

15
03/01/2023 01/01/2023 - N/A Currently in Effect You are here

16