Key facts for NCD 20.8.1.1
- Benefit category
- Outpatient Hospital Services Incident to a Physician's Service
- Effective date
- 10/03/2003
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.8.1.1 sets Medicare's national policy for transtelephonic monitoring of cardiac pacemakers under the benefit category "Outpatient Hospital Services Incident to a Physician's Service", effective 10/03/2003. In order for transtelephonic monitoring services to be covered, the services must consist of the following elements: It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Transtelephonic monitoring of pacemakers is furnished by commercial suppliers, hospital outpatient departments, and physicians’ offices.
Telephone monitoring of cardiac pacemakers as described below is medically efficacious in identifying early signs of possible pacemaker failure, thus reducing the number of sudden pacemaker failures requiring emergency replacement. All systems that monitor the pacemaker rate (bpm) in both the free-running and/or magnetic mode are effective in detecting subclinical pacemaker failure due to battery depletion. More sophisticated systems are also capable of detecting internal electronic problems within the pulse generator itself and other potential problems. In the case of dual-chamber pacemakers in particular, such monitoring may detect failure of synchronization of the atria and ventricles, and the need for adjustment and reprogramming of the device.
NOTE: The transmitting device furnished to the patient is simply one component of the diagnostic system, and is not covered as durable medical equipment. Those engaged in transtelephonic pacemaker monitoring should reflect the costs of the transmitters in setting their charges for monitoring.
Indications and limitations of coverage
B. Definition of Transtelephonic Monitoring
In order for transtelephonic monitoring services to be covered, the services must consist of the following elements:
• A minimum 30-second readable strip of the pacemaker in the free-running mode;
• Unless contraindicated, a minimum 30-second readable strip of the pacemaker in the magnetic mode; and
• A minimum 30 seconds of readable ECG strip.
C. Frequency Guidelines for Transtelephonic Monitoring
The guidelines below constitute a system which Medicare Administrative Contractors (MACs) should use, in conjunction with their knowledge of local medical practices, to screen claims for transtelephonic monitoring prior to payment. It is important to note that they are not recommendations with respect to a minimum frequency for such monitorings, but rather a maximum frequency (within which payment may be made without further claims development). As with previous guidelines, more frequent monitorings may be covered in cases where MACs are satisfied that such monitorings are medically necessary; e.g., based on the condition of the patient, or with respect to pacemakers exhibiting unexpected defects or premature failure. MACs should seek written justification for more frequent monitorings from the patient’s physician and/or any monitoring service involved.
These guidelines are divided into two broad categories - Guideline I which will apply to the majority of pacemakers now in use, and Guideline II which will apply only to pacemaker systems (pacemaker and leads) for which sufficient long-term clinical information exists to assure that they meet the standards of the Inter-Society Commission for Heart Disease Resources (ICHD) for longevity and end-of-life decay. (The ICHD standards are: (1) 90% cumulative survival at 5 years following implant; and (2) an end-of-life decay of less than a 50% drop of output voltage and less than 20% deviation of magnet rate, or a drop of 5 beats per minute or less, over a period of 3 months or more.) MACs should consult with their medical advisers and other appropriate individuals and organizations (such as the North American Society of Pacing and Electrophysiology which publishes product reliability information) should questions arise over whether a pacemaker system meets the ICHD standards.
The two groups of guidelines are then further broken down into two general categories – single-chamber and dual-chamber pacemakers. MACs should be aware that the frequency with which a patient is monitored may be changed from time-to-time for a number of reasons, such as a change in the patient’s overall condition, a reprogramming of the patient’s pacemaker, the development of better information on the pacemaker’s longevity or failure mode, etc. Consequently, changes in the proper set of guidelines may be required. MACs should inform physicians and monitoring services to alert MACs to any changes in the patient’s monitoring prescription that might necessitate changes in the screening guidelines applied to that patient. (Of particular importance is the reprogramming of a dual-chamber pacemaker to a single-chamber mode of operation. Such reprogramming would shift the patient from the appropriate dual-chamber guideline to the appropriate single-chamber guideline.)
Such reprogramming would shift the patient from the appropriate dual-chamber guideline to the appropriate single-chamber guideline.)
Guideline I
1 - Single-chamber pacemakers
1st month - every 2 weeks.
2nd through 36th month - every 8 weeks.
37th month to failure - every 4 weeks.
2 - Dual-chamber pacemaker
1st month - every 2 weeks.
2nd through 6th month - every 4 weeks.
7th through 36th month - every 8 weeks.
37th month to failure - every 4 weeks.
Guideline II
1 - Single-chamber pacemakers
1st month - every 2 weeks.
2nd through 48th month - every 12 weeks.
49th through 72nd month - every 8 weeks.
Thereafter - every 4 weeks.
2 - Dual-chamber pacemaker
1st month - every 2 weeks.
2nd through 30th month - every 12 weeks.
31st through 48th month - every 8 weeks.
Thereafter - every 4 weeks.
D. Pacemaker Clinic Services
1. General
Pacemaker monitoring is also covered when done by pacemaker clinics. Clinic visits may be done in conjunction with transtelephonic monitoring or as a separate service; however, the services rendered by a pacemaker clinic are more extensive than those currently possible by telephone. They include, for example, physical examination of patients and reprogramming of pacemakers. Thus, the use of one of these types of monitoring does not preclude concurrent use of the other.
2. Frequency Guidelines
As with transtelephonic pacemaker monitoring, the frequency of clinic visits is the decision of the patient’s physician, taking into account, among other things, the medical condition of the patient. However, MACs can develop monitoring guidelines that will prove useful in screening claims. The following are recommendations for monitoring guidelines on lithium-battery pacemakers:
• For single-chamber pacemakers - twice in the first 6 months following implant, then once every 12 months.
• For dual-chamber pacemakers - twice in the first 6 months, then once every 6 months.
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.8.1.1 version 1. View the original on cms.gov.
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 20.8.1.1
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 20.8.1.1
What does NCD 20.8.1.1 cover?
B. Definition of Transtelephonic Monitoring The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.8.1.1 take effect?
The current version (1) is effective 10/03/2003. This is the only published version.
Does a Local Coverage Determination override NCD 20.8.1.1?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
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 NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.