Ask Dr. Z

Good Morning, We are having some difficulty with medical necessity for an ICD. Our facility has created a form based on the Medicare NCD to ensure patients are meeting the criteria for implant. We have a patient that is falling out based on class I heart failure. The physician has stated the patient still meets medical necessity because they are meeting the MADIT II criteria. The patient has ischemic cardiomyopathy, h/o MI, and EF of 25% and class I heart failure. Can you please help us determine if patients that are meeting MADIT II criteria automatically meet the Medicare medical necessisty criteria for implant? Thank you for your assistance!