CMS Pub. 100-03, ch. 1, § 20.12

CIM 35-78

Diagnostic endocardial electrical stimulation (EES), also called programmed electrical

stimulation of the heart, is covered under Medicare when used for patients with severe

cardiac arrhythmias.

Diagnostic endocardial electrical stimulation involves the detection and stimulation of

cardiac electrical activity for the purpose of studying arrhythmias and abnormalities of

the heart’s conduction system. Intracardiac electrode catheters, intracardiac and

extracardiac recordings and a stimulator device are required. From two to six multi-polar

electrode catheters are inserted percutaneously, usually through the femoral veins, and

advanced to the heart under fluoroscopic control. Other venous or arterial routes may be

employed as well. An intracardiac His bundle cardiogram is usually obtained during EES

as are conventional electrocardiograms. No separate charge will be recognized for the

His Bundle cardiogram. (See §20.16.)

The EES is used to investigate the mechanisms, site of origin and pathways of cardiac

arrhythmias as well as to select therapeutic approaches for their resolution. EES is also

employed to identify patients at risk of sudden arrhythmic death. The principal use for

EES is in the diagnosis and treatment of sustained ventricular tachycardia. However, it

has also proven to be of value in the diagnosis and management of other complex

arrhythmias, conduction defects, and after cardiac arrest.