CMS Pub. 100-04, ch. 32, § 418

Effective October 28, 2025, the Centers for Medicare & Medicaid Services (CMS) covers CCM used for the

treatment of HF under Coverage with Evidence Development (CED) according to the criteria outlined in

NCD manual, chapter 1, section 20.39. Consistent with section 1142 of the Act, AHRQ supports clinical

research studies that CMS determines meet all the criteria and standards identified above.

CCM used for the treatment of HF is not covered for patients outside of a CMS-approved study.

418.1 Coding Requirements for Cardiac Contractility Modulation (CCM) for Heart

Failure (HF)

(Rev. 13806, Issued: 05-28-26, Effective: 10-28- 25, Implementation: 04- 06-26)

The following CPT codes are applicable for CCM:

Insertion/Replacement procedures

0408T - Insertion or replacement of permanent cardiac contractility modulation system, including

contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse

generator with transvenous electrodes

0409T- Insertion or replacement of permanent cardiac contractility modulation system, including

contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse

generator only

0410T- Insertion or replacement of permanent cardiac contractility modulation system, including

contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial

electrode only

0411T- Insertion or replacement of permanent cardiac contractility modulation system, including

contractility evaluation when performed, and programming of sensing and therapeutic parameters;

ventricular electrode only

Removal procedures

0412T-Removal of permanent cardiac contractility modulation system; pulse generator only

0413T- Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or

ventricular)

0414T- Removal and replacement of permanent cardiac contractility modulation system pulse generator only

Repositioning procedures

0415T- Repositioning of previously implanted cardiac contractility modulation transvenous electrode (atrial

or ventricular lead)

0416T- Relocation of skin pocket for implanted cardiac contractility modulation pulse generator

Programming procedures

0417T- Programming device evaluation (in person) with iterative adjustment of the implantable device to

test the function of the device and select optimal permanent programmed values with analysis, including

review and report, implantable cardiac contractility modulation system

0418T- Interrogation device evaluation (in person) with analysis, review and report, includes connection,

recording and disconnection per patient encounter, implantable cardiac contractility modulation system

The following PCS codes are applicable for insertion/replacement for CCM:

0JH60AZ- Insertion of Contractility Modulation Device into Chest Subcutaneous Tissue and Fascia, Open

Approach

0JH63AZ- Insertion of Contractility Modulation Device into Chest Subcutaneous Tissue and Fascia,

Percutaneous Approach

0JH80AZ- Insertion of Contractility Modulation Device into Abdomen Subcutaneous Tissue and Fascia,

Open Approach

0JH83AZ- Insertion of Contractility Modulation Device into Abdomen Subcutaneous Tissue and Fascia,

Percutaneous Approach

02H63MZ- Insertion of cardiac lead into right atrium, percutaneous approach (when specified as a lead for a

contractility modulation device)

02HK3MZ- Insertion of cardiac lead into right ventricle, percutaneous approach (when specified as a lead

for a contractility modulation device)

The following HCPCS codes are applicable for CCM:

C1824- Generator, cardiac contractility modulation (implantable)

C1898- Lead, pacemaker, other than transvenous VDD single pass

NOTE: HCPCS codes C 1824 and C1898 are not separately paid, as the payment is packaged

and considered part of the eligible comprehensive procedure.

K1030- External recharging system for battery (internal) for use with implanted cardiac contractility

modulation generator, replacement only. Contractors shall establish local fee schedule amounts to pay claims

for HCPCS K1030, when applicable.

The following ICD-10-CM diagnosis codes are applicable for CCM:

I50.1- Left ventricular failure, unspecified

I50.20- Acute combined systolic (congestive) and diastolic (congestive) heart failure

I50.21- Acute systolic (congestive) heart failure

I50.22- Chronic systolic (congestive) heart failure

I50.23- Acute on chronic systolic (congestive) heart failure

I50.30- Unspecified diastolic (congestive) heart failure

I50.31- Acute diastolic (congestive) heart failure

I50.32- Chronic diastolic (congestive) heart failure

I50.33- Acute on chronic diastolic (congestive) heart failure

I50.40- Unspecified combined systolic (congestive and diastolic (congestive) heart failure

I50.41- Acute combined systolic (congestive) and diastolic (congestive) heart failure

I50.42- Chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.43- Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure

I50.810- Right heart failure, unspecified

I50.811- Acute right heart failure

I50.812- Chronic right heart failure

I50.813- Acute on chronic right heart failure

I50.814- Right heart failure due to left heart failure

I50.82- Biventricular heart failure

I50.83- High output heart failure

I50.84- End stage heart failure

I50.89- Other heart failure

I50.9- Heart failure, unspecified

Z00.6- encounter for examination for normal comparison and control in a clinical research program

(reported as other diagnosis)

418.2 Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for

Heart Failure (HF) Professional Claims

(Rev. 13806, Issued: 05-28-26, Effective: 10-28- 25, Implementation: 04- 06-26)

Professional claims for CCM in a clinical research study shall be covered when billed with:

• one of the HCPCS/CPT codes listed in section 418.1

• one of the ICD-10 diagnosis codes listed in section 418.1

• ICD-10 Z00.6 (as other diagnosis code)

• Place of Service 11, 19, 21, 22, 24, 26, 71, or 72

• the 8-digit clinical trial identifier number

• Modifier Q0

418.3 Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for

Heart Failure (HF) Institutional Claims

(Rev. 13806, Issued: 05-28-26, Effective: 10-28- 25, Implementation: 04- 06-26)

Institutional claims for CCM in a clinical research study shall be covered when billed with:

• TOB 11X

• one of the PCS codes listed in section 418.1

• one of the ICD-10 diagnosis codes listed in section 418.1

• ICD-10 Z00.6 (as other diagnosis code)

• Condition code 30

• Value Code D4 to indicate the 8-digit clinical trial identifier number

OR

• 012X, 013X, or 085X; and

• one of the CPT codes listed in section 418.1

• one of the HCPCS codes listed in section 418.1

• Value code D4 with the 8-digit with the NCT number, and

• Condition code 30 (claim level) or modifier Q0 (line level), and

• ICD-10-CM diagnosis Z00.6 (as other diagnosis), and

• One of the ICD-10-CM diagnosis codes listed in section 418.1 (as principal diagnosis)

418.4 Messages

(Rev. 13806, Issued: 05-28-26, Effective: 10-28- 25, Implementation: 04- 06-26)

Contractors shall use the following messages when denying CCM claims submitted with missing/incorrect

ICD-10 diagnosis code:

Claim Adjustment Reason Code (CARC) 167: “This (these) diagnosis(es) is (are) not covered".

Remittance Advice Remark Code (RARC) N386: “This decision was based on a National Coverage

Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service

is covered. If you do not have web access, you may contact the contractor to request a copy of the NCD.

Group Code – CO (Contractual Obligation) or PR (Patient Responsibility) dependent upon liability.

Use PR when:

• On institutional claims, Occurrence Code 32 (claim level) is present. Modifier Q0 (line level).

Medicare Summary Notice (MSN) 15.20: “The following policies were used when we made this decision:

NCD 20.39”.

Spanish Version – “Las siguientes políticas fueron utilizadas cuando se tomó esta decisión: NCD 20.39.

Contractors shall return as unprocessable line-items on CCM claims in a clinical research study when billed

without the clinical trial number using the following messages:

CARC 16: Claim/service lacks information or has submission/billing error(s).

RARC MA50: Missing/incomplete/invalid Investigational Device Exemption number or clinical trial

number.

Group Code: CO

Contractors shall return as unprocessable line-items on CCM claims containing one of the CPT or HCPCS

codes mentioned in Section 415.1 when billed without modifier Q0 using the following messages:

CARC 4: The procedure code is inconsistent with the modifier used.

RARC N519: Invalid combination of HCPCS modifiers.

Group Code: CO

Contractors shall return as unprocessable claims for CCM services when services were billed in other than

Place of Service (POS) 11, 19, 21, 22, 24, 26, 71, or 72 and use the following messages:

CARC 58: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of

service.

Remittance Advice Remark Code (RARC) N386: “This decision was based on a National Coverage

Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service

is covered. If you do not have web access, you may contact the contractor to request a copy of the NCD.

Group Code: CO