Summary
Independence Blue Cross reissued MA05.067f with no substantive changes to leadless pacemaker coverage policy. The only modification was the addition of HCPCS code C1605 (dual-chamber leadless pacemaker) effective 07/01/2024. Leadless pacemakers remain experimental/investigational and are only covered under Medicare's Coverage with Evidence Development (CED) program when patients are enrolled in approved clinical studies.
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What to do
Action · 4 steps
01By 07/01/2024: Billing team must update billing system to recognize HCPCS code C1605 (leadless dual-chamber pacemaker) and ensure all leadless pacemaker procedure codes (0795T-0804T, 0823T-0826T, 33274, 33275, C1605) are submitted with Modifier Q0 to indicate investigational clinical service in a CMS-approved CED study.
02Verify patient enrollment in an approved CMS CED clinical study before processing claims.
03Maintain documentation of CED study enrollment in patient record.
04Claims submitted without Modifier Q0 or without evidence of CED enrollment will be denied.
Codes mentioned
3327433275C1605Z00.6
Original notice
MA05.067f, Leadless Pacemakers
medpolicy.ibx.com · Always check the source before changing claims.
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