Key facts for NCD 20.8.3
- Benefit category
- Inpatient Hospital Services, Physicians' Services, Prosthetic Devices
- Effective date
- 08/13/2013
- Implemented 01/13/2016
- Transmittal
- Transmittal 187
- Versions published
- 2
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.8.3 sets Medicare's national policy for single chamber and dual chamber permanent cardiac pacemakers under the benefit category "Inpatient Hospital Services, Physicians' Services, Prosthetic Devices", effective 08/13/2013 and implemented 01/13/2016. The following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers: It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Permanent cardiac pacemakers refer to a group of self-contained, battery operated, implanted devices that send electrical stimulation to the heart through one or more implanted leads. They are often classified by the number of chambers of the heart that the devices stimulate (pulse or depolarize). Single chamber pacemakers typically target either the right atrium or right ventricle. Dual chamber pacemakers stimulate both the right atrium and the right ventricle.
The implantation procedure is typically performed under local anesthesia and requires only a brief hospitalization. A catheter is inserted into the chest and the pacemaker’s leads are threaded through the catheter to the appropriate chamber(s) of the heart. The surgeon then makes a small “pocket” in the pad of the flesh under the skin on the upper portion of the chest wall to hold the power source. The pocket is then closed with stitches.
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is sufficient to conclude that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Symptoms of bradycardia are symptoms that can be directly attributable to a heart rate less than 60 beats per minute (for example: syncope, seizures, congestive heart failure, dizziness, or confusion).
Indications and limitations of coverage
B. Nationally Covered Indications
The following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers:
• Documented non-reversible symptomatic bradycardia due to sinus node dysfunction, and
• Documented non-reversible symptomatic bradycardia due to second degree and/or third degree atrioventricular block.
C. Nationally Non-Covered Indications
The following indications are non-covered for implanted permanent single chamber or dual chamber cardiac pacemakers:
• Reversible causes of bradycardia such as electrolyte abnormalities, medications or drugs, and hypothermia,
• Asymptomatic first degree atrioventricular block,
• Asymptomatic sinus bradycardia,
• Asymptomatic sino-atrial block or asymptomatic sinus arrest,
• Ineffective atrial contractions (e.g., chronic atrial fibrillation or flutter, or giant left atrium) without symptomatic bradycardia,
• Asymptomatic second degree atrioventricular block of Mobitz Type I unless the QRS complexes are prolonged or electrophysiological studies have demonstrated that the block is at or beyond the level of the His Bundle (a component of the electrical conduction system of the heart),
• Syncope of undetermined cause,
• Bradycardia during sleep,
• Right bundle branch block with left axis deviation (and other forms of fascicular or bundle branch block) without syncope or other symptoms of intermittent atrioventricular block,
• Asymptomatic bradycardia in post-myocardial infarction patients about to initiate long-term beta-blocker drug therapy,
• Frequent or persistent supraventricular tachycardias, except where the pacemaker is specifically for the control of tachycardia, and
• A clinical condition in which pacing takes place only intermittently and briefly, and which is not associated with a reasonable likelihood that pacing needs will become prolonged.
D. Other
Medicare Administrative Contractors will determine coverage under section 1862(a)(1)(A) of the Social Security Act for any other indications for the implantation and use of single chamber or dual chamber cardiac pacemakers that are not specifically addressed in this national coverage determination.
(This NCD last reviewed August 2013.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.8.3 version 2. View the original on cms.gov.
Revision history
12/2015 - Transmittal 186, dated October 26, 2015, is being rescinded and replaced by Transmittal 187, dated December 10, for the following reason:
The National Coverage Determination (NCD) for Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD20.8.3) was effective on August 13, 2013, and remains in effect. In order to address claims processing issues that were brought to the attention of the Centers for Medicare & Medicaid Services, we have instructed Medicare Administrative Contractors (MACs) to implement this NCD at the local level until CMS is able to revise the formal claims processing instructions. All aspects of the NCD policy in Publication 100-03, NCD Manual, section 20.8.3, remain in effect. Additionally, we are temporarily removing the corresponding Claims Processing Manual, Publication 100-04, chapter 32, section 320, and all but two business requirements to avoid confusion and better clarify that the MACs will use their discretionary authority to process these claims. ( TN 187 ) (CR9078)
10/2015 - Transmittal 179, dated February 20, 2015, is being rescinded and replaced by Transmittal 186, dated October 26, 2015, for the following reason:
The National Coverage Determination (NCD) for Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers (NCD20.8.3) was effective on August 13, 2013, and remains in effect. In order to address claims processing issues that were brought to the attention of the Centers for Medicare & Medicaid Services, we have instructed Medicare Administrative Contractors (MACs) to implement this NCD at the local level until CMS is able to revise the formal claims processing instructions. All aspects of the NCD policy in Publication 100-03, NCD Manual, section 20.8.3, remain in effect. Additionally, we are temporarily removing the corresponding Claims Processing Manual, Chapter 32, section 320, and reference to the manual in requirement 9078-03.1 and 9078-03.2. All other information remains the same. ( TN 186 ) (CR9078)
02/2015 - The purpose of this CR is to inform contractors that CMS issued a National Coverage Determination (NCD and concluded that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block. Effective date: 08/13/2013 Implementation date: 07/06/2015 ( TN 179 ) (CR9078)
07/2014 - MEDICARE ADMINISTRATIVE CONTRACTOR (A/MAC, B/MAC) IMPLEMENTATION OF CR 8525 IS DELAYED UNTIL FURTHER DIRECTION FROM CMS. THEREFORE, TRANSMITTAL 161, DATED FEBRUARY 6, 2014, IS RESCINDED AND REPLACED BY TRANSMITTAL 170, dated July 10, 2014 TO INDICATE AN IMPLEMENTATION DATE YET TO BE DETERMINED. ( TN 170 ) (CR8525)
02/2014 - The purpose of this Change Request (CR) is effective for claims with dates of service on or after August 13, 2013, contractors shall allow payment for nationally covered implanted permanent cardiac pacemakers, single chamber or dual chamber, for the indications outlined in the manuals for this CR. Effective date: 08/13/2013 Implementation date: 07/07/2014 ( TN 161 ) (CR8525)
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 20.8.3
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 20.8.3
What does NCD 20.8.3 cover?
The following indications are covered for implanted permanent single chamber or dual chamber cardiac pacemakers: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.8.3 take effect?
The current version (2) is effective 08/13/2013, implemented 01/13/2016, published in transmittal 187. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 20.8.3?
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.