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Cardiac Resynchronization Therapy (CRT) Coverage Document

Published on 

Wednesday, February 9, 2022

 | FAQ 
Question

Has Palmetto GBA finalized its coverage determination for Cardiac Resynchronization Therapy (CRT)?

Answer

Yes. The coverage determination became effective December 12, 2021 and can be found in Palmetto GBAs’ Local Coverage Article A58821 (link) and Palmetto GBAs’ Local Coverage Determination L39080 (link).

As with most of the other Medicare coverage guidelines, CRT has specific diagnosis codes that must be submitted on the claim to support medical necessity. In addition, the medical record must have documentation of the patient’s QRS duration - reflected in milliseconds - from the EKG, as well as documentation of QRS morphology such as right / left bundle branch block. Check the LCA and LCD for complete coverage requirements.

Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.