Medicare AdvantageCoverageMedium impact
Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery, Critical Care +1 more·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Summary
This is a revised Medicare Advantage policy for Cardioverter Defibrillators and Cardiac Resynchronization Therapy devices, effective August 3, 2026. The policy clarifies coverage for implantable devices (TV-ICD, S-ICD, EV-ICD), CRT devices, and external wearable defibrillators, and references specific CMS National Coverage Determinations and Local Coverage Determinations by geographic MAC jurisdiction. Billing teams must ensure claims align with the appropriate MAC's LCD based on patient location and device type.
Action Required
By August 3, 2026: Billing team must update claim submission protocols to verify patient location and apply the correct MAC's Local Coverage Determination (LCD) for cardioverter defibrillator and cardiac resynchronization therapy claims. For DME MAC jurisdictions (DME A, B, C, D), reference LCAs L33690 and A52458 for device coverage. For Part A/B MAC jurisdictions (JJ and JM), reference LCD L39080 and LCA A58821 for CRT coverage. Verify defibrillation threshold (DFT) testing (CPT 93640, 93641, 93642, 93644) meets medical necessity criteria per Humana's interpretation guidelines. Ensure ICD removal claims (CPT 33241, 33244) are documented for infection or replacement. Claims submitted without proper MAC jurisdiction verification or missing required documentation per CMS IOMs (Pub. 100-02 Ch. 15 §120, Pub. 100-04 Ch. 32 §270) will be denied. Update billing system to cross-reference NCD 20.4 for all ICD types and route claims to appropriate MAC based on geography.