Defibrillators
Medicare Coverage Information
Overview
Medicare provides coverage for medically necessary implantable cardioverter defibrillators (ICDs) for patients with specific heart conditions. Coverage typically includes the device, implantation procedure, and related medical services when prescribed by a Medicare-approved physician.
- Medicare Part B and Medicare Advantage plans may cover defibrillators
- Coverage requires documented medical necessity for heart condition treatment
- Devices must be prescribed by a qualified healthcare professional
- Patients must meet specific cardiac health criteria for coverage
- Outpatient and inpatient defibrillator procedures may be covered differently
- Medicare beneficiaries with qualifying heart conditions
- Patients with documented high-risk cardiac arrhythmias
- Individuals who have failed other heart treatments
- Must be enrolled in Original Medicare or Medicare Advantage
- Typically covered under Medicare Part B after meeting annual deductible
- Beneficiaries may pay approximately 20% of the Medicare-approved cost
- Total out-of-pocket costs can vary based on specific Medicare plan
- Additional costs may apply for hospital services and physician fees
- Must be deemed medically necessary by Medicare guidelines
- Requires prior authorization and documentation of heart condition
- Limited to specific types of FDA-approved defibrillator devices
- Coverage may depend on specific cardiac diagnosis and treatment history
- Consult with your cardiologist about medical necessity
- Get a detailed prescription and medical documentation
- Contact Medicare directly to confirm specific coverage details
- Verify device and implantation procedure with your insurance provider
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare defibrillatorsICD coverageheart device Medicaremedical device insurancecardiac care Medicare
Related Coverage Topics
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