Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56602 (Billing and Coding: Cardiac Rhythm Device Evaluation) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56602: Billing and Coding: Cardiac Rhythm Device Evaluation (Billing and Coding, effective 2025-01-01)
- Covered ICD-10-CM codes
- 158
- 2 groups
- Non-covered ICD-10-CM codes
- 1
- Procedure codes listed
- 18
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| I21.01 | — |
| I21.02 | — |
| I21.09 | — |
| I21.11 | — |
| I21.19 | — |
| I21.21 | — |
| I21.29 | — |
| I21.3 | — |
| I21.4 | — |
| I21.9 | — |
| I22.0 | — |
| I22.1 | — |
| I22.2 | — |
| I22.8 | — |
| I22.9 | — |
| I25.10 | — |
| I25.2 | — |
| I25.5 | — |
| I25.6 | — |
| I25.810 | — |
| I25.811 | — |
| I25.812 | — |
| I25.89 | — |
| I25.9 | — |
Procedure codes: 93260, 93261, 93279, 93280, 93281, 93282, 93283, 93284, 93286, 93287, 93288, 93289, 93292, 93293, 93294, 93295, 93296, 93724.
Coverage indications, limitations and medical necessity
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.
History/Background and/or General Information
Electronic analysis to monitor the patient’s pacemaker or cardioverter-defibrillator is medically necessary on a regular basis to evaluate the device. Pre and postoperative evaluation of the cardiac rhythm device in patients with implantable cardioverter-defibrillators (ICDs) or who are pacer dependent may be necessary because electromagnetic interference can alter the function of these devices, especially ICDs, in unpredictable ways. They may need to be re-programmed before and after a surgical procedure.
Covered Indications and Limitations
Please refer to NCD 20.8.1 Cardiac Pacemaker Evaluation Services for indications and limitations of coverage for the post-implant follow-up and evaluation of implanted cardiac pacemakers.
Transtelephonic Monitoring of Cardiac Pacemakers
Please refer to NCD 20.8.1.1 Transtelephonic Monitoring of Cardiac Pacemakers for general information, definition of transtelephonic monitoring, frequency guidelines for transtelephonic monitoring, and pacemaker clinic services.
For instances where a patient is monitored both during clinic visits and remotely or transtelephonically, the combined frequency of monitoring will be considered in evaluating the reasonableness of the frequency of monitoring services received by the patient.
Note : Payment for dual-chamber pacemakers operating in single-chamber mode should be made at the same frequency as monitoring of a single-chamber pacemaker.
Local Medicare Frequency Guidelines for Monitoring of Cardioverter-Defibrillators
Electronic analysis of a pacing cardioverter-defibrillator is performed in an office or outpatient hospital setting. It involves the interrogation and evaluation of the pulse generator status in addition to evaluation of the programmable parameters, analysis of event markers, and device response during periods of rest and activity. The monitoring of these complex devices requires more frequent monitoring than a single- or dual-chamber pacemaker. Therefore, Medicare will allow routine electronic analysis of a pacing cardioverter-defibrillator (single- and dual-chamber) within one month following implantation and then every three months thereafter. More frequent testing may be necessary to evaluate patient symptoms suggestive of pacing cardioverter-defibrillator involvement/origin.
Wearable Defibrillator System
Payment for wearable defibrillators is made by Durable Medical Equipment (DME) contractors and is subject to the indications and limitations in the DME Local Coverage Determination “Automatic External Defibrillators.”
Coverage (including frequency) for monitoring the wearable system is identical to that of implantable defibrillator devices.
Notice: Services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in this LCD.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2020-08-13
- Last reviewed by the contractor
- 2018-03-01
- MCD version
- 94
- Derived from
- L30529
The contractor lists 4 National Coverage Determinations as related: NCD 20.8 Cardiac Pacemakers, NCD 20.8.1 Cardiac Pacemaker Evaluation Services, NCD 20.8.1.1 Transtelephonic Monitoring of Cardiac Pacemakers, NCD 20.8.3 Single Chamber and Dual Chamber Permanent Cardiac Pacemakers. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Novitas Solutions, Inc. hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34833 cover?
Electronic analysis to monitor the patient’s pacemaker or cardioverter-defibrillator is medically necessary on a regular basis to evaluate the device. Pre and postoperative evaluation of the cardiac rhythm device in patients with implantable cardioverter-defibrillators (ICDs) or who are pacer dependent may be necessary because electromagnetic interference can alter the function of these devices, especially ICDs, in… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34833 apply to?
Novitas Solutions, Inc. applies it to Medicare claims in AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34833?
The companion billing and coding article A56602 lists 158 ICD-10-CM codes in 2 groups that support medical necessity and 1 that do not; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34833?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.