Medicare National Coverage Determinations (NCD) Manual (Pub. 100-03), Ch. 1 § 20.8.2
Self-Contained Pacemaker Monitors
20.8.2 - Self-Contained Pacemaker Monitors
(Rev. 1, 10-03-03)
CIM 60-7
Self-contained pacemaker monitors are accepted devices for monitoring cardiac pace-
makers. Accordingly, program payment may be made for the rental or purchase of either
of the following pacemaker monitors when a physician for a patient prescribes it with a
cardiac pacemaker:
A. Digital Electronic Pacemaker Monitor
This device provides the patient with an instantaneous digital readout of his pacemaker
pulse rate. Use of this device does not involve professional services until there has been
a change of five pulses (or more) per minute above or below the initial rate of the
pacemaker; when such change occurs, the patient contacts his physician.
B. Audible/Visible Signal Pacemaker Monitor
This device produces an audible and visible signal which indicates the pacemaker rate.
Use of this device does not involve professional services until a change occurs in these
signals; at such time, the patient contacts his physician.
NOTE: The design of the self-contained pacemaker monitor makes it possible for the
patient to monitor his pacemaker periodically and minimizes the need for regular visits to
the outpatient department of the provider.
Therefore, documentation of the medical necessity for pacemaker evaluation in the
outpatient department of the provider should be obtained where such evaluation is
employed in addition to the self-contained pacemaker monitor used by the patient in his
home.
Cross-reference: §20.8.1