Summary & Overview
HCPCS C1895: Lead, ICD Endocardial Dual Coil (Implantable)
HCPCS Level II code C1895 identifies an endocardial dual-coil lead used with implantable cardioverter-defibrillators (ICDs). This component is essential to ICD systems that deliver defibrillation and pacing therapy to patients at risk of life-threatening ventricular arrhythmias. Nationally, accurate coding of device components like C1895 affects device supply reimbursement, inventory tracking, and clinical documentation tied to complex cardiac procedures.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage and billing considerations across major commercial payers and Medicare, benchmarks for typical site-of-service utilization, and the clinical context for use of dual-coil transvenous ICD leads.
The publication provides practical reference material on coding nomenclature and service classification, clarifies where C1895 fits within procedural billing for ICD implantation, and flags areas where policy updates and payer-specific coverage edits commonly arise. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C1895 describes a lead for an implantable cardioverter-defibrillator (ICD), endocardial dual coil. The item is a transvenous endocardial lead with two shock coils intended for implantation as part of an ICD system to provide ventricular defibrillation and pacing therapies.
Service type: Implantable cardiac device component (ICD lead placement and supply)
Typical site of service: Inpatient or outpatient hospital setting, cardiac catheterization lab, or specialized electrophysiology procedural suite
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy (left ventricular ejection fraction 28%), prior myocardial infarction, and documented episodes of sustained ventricular tachycardia is evaluated for primary prevention of sudden cardiac death. After multidisciplinary evaluation including cardiology and electrophysiology, the patient is scheduled for implantation of a transvenous implantable cardioverter-defibrillator (ICD) system. The procedure includes vascular access (typically via the subclavian or axillary vein), transvenous placement of an endocardial dual-coil defibrillator lead positioned with one coil in the right ventricular septum/apex and a second coil in the superior vena cava/right atrium junction, lead testing for sensing and pacing thresholds, and connection to the ICD generator placed in a subcutaneous or submuscular pocket. Typical site of service is the hospital operating room, cardiac catheterization lab, or ambulatory surgery center equipped for electrophysiology procedures. Typical perioperative workflow includes pre-procedure device interrogation and imaging review, sterile lead implantation under fluoroscopic guidance, intraoperative lead parameter assessment, device programming and defibrillation threshold testing as indicated, pocket closure, and post-procedure monitoring with chest radiograph to confirm lead position and rule out pneumothorax. Common clinical indications include primary or secondary prevention of sudden cardiac death for ischemic or nonischemic cardiomyopathy, survivors of cardiac arrest due to ventricular fibrillation, and recurrent sustained ventricular tachycardia not controlled with antiarrhythmic therapy.
Coding Specifications
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