405 IAC 5-28-6 - Monitoring of pacemakers
Current through March 30, 2022
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 6.
(a) Medicaid
reimbursement is available for clinic and telephone monitoring of cardiac
pacemakers based upon the restrictions in this section.
(b) Frequency of monitoring, unless
sufficiently documented by the physician on the Medicaid medical claim form,
shall not exceed the following:
(1) For clinic
monitoring of lithium battery pacemakers with single-chamber pacemakers, twice
in the first six (6) months following implant, then once every twelve (12)
months.
(2) For clinic monitoring
of lithium battery pacemakers with dual-chamber pacemakers, twice in the first
six (6) months following implant, then once every six (6) months.
(3) For telephone monitoring with
single-chamber pacemaker following the first month of the implant, once every
two (2) weeks.
(4) For telephone
monitoring with single-chamber pacemaker following the second month of the
implant through the thirty-sixth month, once every eight (8) weeks.
(5) For telephone monitoring with
single-chamber pacemaker following the thirty-seventh month of the implant
through failure, once every four (4) weeks.
(6) For telephone monitoring with
dual-chamber pacemaker following the first month of the implant, once every two
(2) weeks.
(7) For telephone
monitoring with dual-chamber pacemaker following the second through the sixth
month of the implant, once every four (4) weeks.
(8) For telephone monitoring with
dual-chamber pacemaker following the seventh through the thirty-sixth month of
the implant, once every eight (8) weeks.
(9) For telephone monitoring with
dual-chamber pacemaker following the seventh through the thirty-seventh month
through failure of the implant, once every four (4) weeks.
(c) The claim form must state the date of the
pacemaker insertion and the type of pacemaker monitored.
Notes
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