Medicare's national coverage determination establishes just two indications for pacemaker implant:
- Documented non-reversible symptomatic bradycardia due to sinus node dysfunction,
- Documented non-reversible symptomatic bradycardia due to second degree and/or third degree AV block.
Due to claims processing difficulties, Medicare rescinded the national claims processing instructions and instructed the Medicare Administrative Contractors to implement coverage and claims processing instructions at the contractor level. Each contractor published identical policies that vastly expanded the list of indications. Each contractor policy is presented below followed by a summary of which states are governed by each contractor.