Skip to Main Content

KMAP BULLETIN: Wearable Cardiac Defibrillator

Date: 11/14/18

KMAP GENERAL BULLETIN 18234 (PDF)

Effective with dates of service on and after January 1, 2019, K0606 is covered as an alternative to an implanted defibrillator when criteria specified are met. A Wearable Cardiac Defibrillator (WCD) is covered for a patient if they meet one of the criteria described below:

  1. A documented episode of ventricular fibrillation or a sustained, lasting 30 seconds or longer, ventricular tachyarrhythmia.
    Note: These dysrhythmias may be either spontaneous or induced during an electrophysiologic (EP) study but may not be due to a transient or reversible cause and may not occur during the first 48 hours of an acute myocardial infarction (ICD-10 codes I47.0, I47.2, I49.01, I49.02).
  2. Familial or inherited conditions with a high risk of life-threatening ventricular tachyarrhythmia, such as long QT syndrome (ICD-10 code I45.81) or hypertrophic cardiomyopathy (ICD-10 code I42.1, I42.2).
  3. Either documented prior myocardial infarction (ICD-10 codes I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I25.2) or dilated cardiomyopathy (ICD-10 code I42.0) and a measured left ventricular ejection fraction less than or equal to 0.35 (LVEF less than or equal to 35%)
  4. A previously implanted defibrillator that now requires explanation due to mechanical complication (ICD-10 codes T82.110A, T82.111A, T82.118A, T82.119A, T82.120A, T82.121A, T82.128A, T82.129A, T82.190A, T82.191A, T82.198A, T82.199A) or infection (ICD-10 codes T82.6XXA, T82.7XXA).

Note: The effective date of the policy is January 1, 2019. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.