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Requirements for ICD Coverage

Date: Mar 30, 2023

Question:

Per Medicare one of the requirements for ICD coverage is that LVEF must be measured by echocardiography, radionuclide (nuclear medicine) imaging, cardiac MRI, or catheter angiography prior to implant. Can you advise on the timeframe requirement/limit for the EF measurement? We have combed through Medicare's coverage database and cannot find a definitive answer. The MD has an echo on file from March 2022 and wants to know if that is sufficient enough for the upcoming implant scheduled in March 2023 or if he has to have another EF measurement performed. The NCD/LCD is very specific about having to be on med therapy for three months, must not have had an MI within 40 days of the date of implant, more than 90 days post PCI/CABG, etc., but not on the timeframe of EF measurement. Any guidance or insight is greatly appreciated!

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