Which coverage policy do we use to allow payment for Implantable Cardiac Defibrillators (ICD) CPT code 33249?
NCD 20.4 is guidance for the Automatic Implantable Cardiac Defibrillator (ICD). There is also an MLN Matters article MM4273 that specifically states what diagnosis codes are payable for this service when not performed as part of a clinical trial. LCDs L11585-NC, L12193-ID, and L6853-TN are for Resynchronization Therapy for Congestive Heart Failure (Biventricular Pacing) and also include CPT code 33249. The information in the MLN Matters article does not apply to these. This CPT code can be used for either service. However, because an NCD always supersedes an LCD follow the guidance of the NCD and the associated MLN Matters Article in billing for this service .
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