Medicare AdvantageCoverageMedium impact
Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)
Humana·Cardiology, Cardiothoracic Surgery·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
This is a revised Medicare Advantage policy for cardioverter defibrillators and cardiac resynchronization therapy devices, effective May 1, 2026. The policy provides updated coverage criteria and coding information for various cardiac device implantation, monitoring, and removal procedures.
Action Required
By May 1, 2026: Billing team must review and update billing procedures for cardiac device procedures to align with revised Medicare Advantage coverage criteria. Ensure documentation requirements for ICD removal procedures specify infection presence or replacement necessity. Verify defibrillation threshold testing coding aligns with updated medical necessity criteria.