Comment & Response |

Pacemaker Indication Must Meet Medicare Coverage Determination

Ronald Hirsch, MD
JAMA Intern Med. 2013;173(17):1658-1659. doi:10.1001/jamainternmed.2013.8474.
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To the Editor In the excellent case presentation of a 74-year-old patient with symptomatic second-degree atrioventricular block with 2:1 conduction, Elkin and Goldschlager1 thoroughly reviewed the differential diagnosis and evaluation but omitted important information in the treatment discussion when they noted that that the patient had a dual-chamber pacemaker implanted.

The Centers for Medicare & Medicaid Services (CMS) has published a national coverage determination (NCD 20.8), specifying when CMS will pay for a pacemaker implantation with criteria for both single-chamber and dual-chamber pacemakers.2 The patient described meets the criteria for a single-chamber pacemaker based on the presence of second-degree atrioventricular heart block of type II but does not meet the criteria for a dual-chamber pacemaker unless accompanied by specific medical documentation. In the absence of physician documentation that supports the decision to proceed with a dual-chamber pacemaker, CMS requires that the patient must meet at least 1 of 4 criteria2:


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