All PlansCoverageMedium impact
Implantable Cardioverter Defibrillator
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Cardiothoracic Surgery, Internal Medicine·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive medical policy for Implantable Cardioverter Defibrillators (ICDs) covering transvenous, subcutaneous, and extravascular devices. The policy defines medically necessary criteria for both primary and secondary prevention indications, including specific conditions like ischemic cardiomyopathy, hypertrophic cardiomyopathy, and cardiac ion channelopathies.
Action Required
Review current ICD billing practices to ensure compliance with medical necessity criteria outlined in this policy. Verify that documentation supports either primary prevention criteria (specific NYHA class, ejection fraction thresholds, timing after MI) or secondary prevention criteria (history of life-threatening ventricular events) before submitting claims. Update prior authorization workflows to reference these specific medical necessity requirements.