NCD 20.28: Cardiac Resynchronization Therapy (CRT)
Medicare covers CRT (and CRT-D) for heart failure patients meeting LVEF, QRS duration, and NYHA class criteria with documented optimal medical therapy.
What's covered
- CRT pacemaker (CRT-P) or defibrillator (CRT-D)
- Implantation and follow-up care
Coverage criteria
- LVEF ≤35%
- NYHA II/III (and select IV)
- QRS ≥130 ms (LBBB preferred)
- Optimal medical therapy ≥3 months
- Sinus rhythm or A-fib with adequate ventricular pacing
Exclusions
- QRS <130 ms (per current evidence)
- Inadequate optimal medical therapy duration
Common denial patterns
- QRS duration not documented
- LBBB morphology not specified (vs RBBB)
- Inadequate OMT duration
Appeal citation
NCD 20.28 (CRT). Cite LVEF, QRS duration and morphology, NYHA class, OMT documentation.
Frequently asked questions
What does Medicare NCD 20.28 cover?
Medicare covers CRT (and CRT-D) for heart failure patients meeting LVEF, QRS duration, and NYHA class criteria with documented optimal medical therapy.
What are the coverage criteria?
LVEF ≤35%; NYHA II/III (and select IV); QRS ≥130 ms (LBBB preferred); Optimal medical therapy ≥3 months; Sinus rhythm or A-fib with adequate ventricular pacing.
What is excluded?
QRS <130 ms (per current evidence); Inadequate optimal medical therapy duration.
How do I cite this NCD in an appeal?
NCD 20.28 (CRT). Cite LVEF, QRS duration and morphology, NYHA class, OMT documentation.
Other Cardiology NCDs
Sources
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