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Subcutaneous Internal Cardiac Defibrillator (S-ICD) to Become a Benefit Effective September 1, 2021

Last updated on 7/16/2021

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective September 1, 2021, subcutaneous internal cardiac defibrillator (S-ICD) will become a benefit for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program including procedure codes 33270, 33271, 33273, 33274, 93287, and 93290.

Insertion or Replacement Services

Effective September 1, 2021, procedure codes 33270 (insertion or replacement) and 33271 (insertion) can be reimbursed as follows:

  • To physician providers for services rendered in the inpatient and outpatient hospital settings
  • To ambulatory surgical center providers for services rendered in the outpatient hospital setting

Removal Services

Effective September 1, 2021, procedure code 33272 for removal can be reimbursed to physician providers for services rendered in the inpatient and outpatient hospital settings.

Repositioning Services

Effective September 1, 2021, procedure code 33273 for repositioning can be reimbursed as follows:

  • To physician providers for services rendered in the inpatient and outpatient hospital settings
  • To ambulatory surgical center providers for services rendered in the outpatient hospital setting

Peri-Procedural and Interrogation Device Evaluation Services

Effective September 1, 2021, procedure codes 93287 and 93290 for peri-procedural and interrogation device evaluation services can be reimbursed as follows:

  • The total component can be reimbursed to physician assistant (PA), nurse practitioner (NP), and clinical nurse specialist (CNS) providers for services rendered in the office, inpatient and outpatient settings.
  • The professional component can be reimbursed to PA, NP, CNS, and physician providers for services rendered in the office, inpatient and outpatient settings.
  • The technical component can be reimbursed:
  • To physician, PA, NP, CNS, portable X-ray supplier, radiological lab, and physiological lab providers for services rendered in the office setting
  • To hospital providers for services rendered in the outpatient hospital setting

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.