National Coverage Analysis (NCA) Tracking Sheet

Implantable Defibrillators

CAG-00157R3

Issue

On December 28, 2004, CMS issued a decision memorandum closing the 2nd reconsideration of the implantable cardioverter defibrillator (ICD) national coverage determination (http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=139).  That reconsideration was a request to expand current coverage of ICDs based upon data collected in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).  However, data from the trial had not yet been published in a peer-reviewed journal and Section 731 of the Medicare Modernization Act required that CMS issue a final decision within 9 months of having accepted the request for an NCD, which in this case occurred on March 30, 2004.  CMS had initiated the NCD process with the expectation that the results of SCD-HeFT, which is the major source of evidence for this decision, would be published no later than December 28, 2004.  Since that did not occur, CMS posted a decision memorandum that maintained previous ICD coverage.

This NCD is being opened as a 3rd reconsideration to continue analysis of data from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) as part of a formal request from Medtronic Inc. to expand coverage to include the study population.   We will expedite finalizing this NCD as soon as the trial data is published.  Information related to this request is available at http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=139.

Benefit Category

Prosthetic Devices

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
12/29/2004

Public Comment Period
12/29/2004 - 01/29/2005
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
01/27/2005
Comments for this NCA
View Public Comments

Contacts

Lead Analysts
JoAnna Baldwin
Lead Medical Officers
Joseph Chin, MD

Medicare Benefit Category Determination Date

Actions Taken

December 29, 2004

Reconsideration of the ICD national coverage determination is opened. Information regarding the original request to expand coverage to the SCD-HeFT population is available at http://www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=139.

January 27, 2005

February 4, 2005

This document [PDF, 82KB] provides a summary of coverage for implantable cardioverter defibrillators (ICDs) as of January 27, 2005. The National Coverage Determination Manual (NCDM 100-3) will be updated in the coming weeks to reflect changes in policy.

February 15, 2005

Information regarding use of the Implantable Cardioverter Defibrillator Abstraction Tool (ICDA) available through the QualityNet Exchange is available at http://www.qnetexchange.org/public/icda.do

Frequently Asked Questions and a printable version of the ICDA data elements are available under the heading “ICDA Tools”.