Clinical Review Criteria: Pacemaker & Cardiac Resynchronization Therapy (CRT-D)
Clinical review criteria governing medical necessity and coverage for single‑chamber, dual‑chamber, leadless pacemakers, and cardiac resynchronization therapy (CRT‑D) for Kaiser Foundation Health Plan of Washington members; applies to Medicare and non‑Medicare populations as described.
MPC approved adopting Medicare coverage criteria of Defibrillator and Pacemaker placement for Medicare and non-Medicare with a 60-day notice required, effective date April 1, 2024.
MPC approved to adopt a non-coverage policy for leadless pacemakers.
Added applicable CPT codes 33274 and 33275 to policy.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.