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Implantable Cardioverter Defibrillator (ICD) - (Effective Date - 2026-06-15) 7.01.06
Effective date
Jun 15, 2026
Identified
Jun 20, 2026
Summary
Excellus policy 7.01.06 Implantable Cardioverter Defibrillator (ICD) has a current effective date of June 15, 2026. The 02/19/26 off-cycle update changed criteria for post cardiac arrest, structural heart disease with sustained VT, syncope of undetermined origin with a positive EP study, and unexplained syncope with sustained VT and normal LV function, and it added separate primary prevention and secondary prevention sections. The policy considers ICDs not medically necessary for incessant VT or VF, for VT or VF due to a reversible cause, and for ablation candidates with no structural heart disease.
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What to do
Action · 3 steps
01Already effective June 15, 2026: Billing team: ICD claims need documentation that the patient meets a primary prevention or secondary prevention indication in Policy Statements I through VII, such as LVEF of 35% or less after at least three months of optimal medical therapy for ischemic cardiomyopathy.
02Policy Guideline I says there should first be a consultation with an electrophysiologist before an ICD is implanted, so document that consultation.
03Subcutaneous ICD claims need documentation of a contraindication to a transvenous ICD, no indication for anti-bradycardia pacing, and no ventricular arrhythmias known or anticipated to respond to anti-tachycardia pacing.
Codes mentioned
3321533216332173321833220332233323033231332403324133243332443324933262332633326433270332713327233273932609326193282932839329593640936419364293644C1721C1722C1882C1895C1896C1899I25.810I25.811I25.812I25.82I25.89I25.9I47.0I47.2I49.9I50.1I50.9
Original notice
Implantable Cardioverter Defibrillator (ICD) - (Effective Date - 2026-06-15) 7.01.06
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs
Excellus BlueCross BlueShield policiesNY policy changesCardiologyCode 33215Code 33216Code 33217Code 33218Code 33220Code 33223Code 33230Code 33231Code 33240Code 33241Code 33243Code 33244Code 33249Code 33262Code 33263Code 33264Code 33270Code 33271Code 33272Code 33273Code 93260Code 93261Code 93282Code 93283Code 93295Code 93640Code 93641Code 93642Code 93644Code C1721Code C1722Code C1882Code C1895Code C1896Code C1899Code I25.810Code I25.811Code I25.812Code I25.82Code I25.89Code I25.9Code I47.0Code I47.2Code I49.9Code I50.1Code I50.9