Heart of Health Policy | Updated Guidance for Performing MRI on Patients with CIEDs

Medicare beneficiaries with implanted pacemakers, cardioverter defibrillators or other cardiac implantable electronic devices (CIEDs) who meet certain criteria are now eligible to receive MRI under an updated national coverage determination (NCD) that took effect on April 10. The ACC Advocacy team developed the following answers to frequently asked questions from providers regarding implementation of the new NCD.

Does the policy require a qualified clinician (physician, nurse practitioner or physician’s assistant) to be in the MRI suite for the duration of the MRI?

No. “Direct supervision” is defined identically in federal regulations for both the hospital and physician office setting. The qualified clinician “must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the [clinician] must be present in the room where the procedure is performed.”

The NCD states that patients must be continuously observed by visual and voice contact and that an Advanced Cardiac Life Support (ACLS) provider be present for the duration of the scan. Doesn’t that mean a qualified clinician needs to be there?

No. It would be inconsistent to allow direct supervision — where the clinician is nearby but not necessarily in the room — but then also require personal presence. Criteria for continuous visual and voice observation and presence of an ACLS provider are described in separate bullets of the policy. The technologist would maintain visual and voice contact. An individual with ACLS certification — who may or may not be the same technologist — must be present. That individual need not be the qualified clinician.

Since the policy requires the device be reinterrogated immediately after the MRI to confirm proper function, what CPT codes should be used?

CPT codes 93286 and 93287 should be billed to report peri-procedural programming of pacemakers and ICDs, respectively. These peri-procedural services are billed before and after the MRI. If one clinician performs both pre- and post-MRI evaluation, the code is reported twice. If one clinician performs the pre-MRI service and a different individual performs the post-MRI evaluation, each would bill once.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: ACC Publications, Cardiology Magazine, Current Procedural Terminology, Physicians' Offices, Advanced Cardiac Life Support, Medicare, Maintenance, Defibrillators, Implantable, Radionuclide Imaging, Magnetic Resonance Imaging, Certification, Pacemaker, Artificial, Nurse Practitioners

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