Cardiac Implantable Device Remote Monitoring: A July 2020 Perspective

Historical clinical and billing context (July 2020): The device prevalence estimates, reimbursement figures, and reported clinical outcome percentages below were presented in 2020; they are not current billing rates or guaranteed outcomes. Remote monitoring of cardiac implantable electronic devices can complement in-person care, and follow-up should be individualized. For evidence-based clinic practices and limitations, consult the 2023 Heart Rhythm Society-led expert consensus.

An estimated three million-plus patients live in the United States with implanted cardiac devices, with 400,000 implanted annually. Follow-up care for these patients continues to evolve and become more challenging due to increasing clinical complexity of patients and diagnostic device features. 

Cardiac implantable electronic devices (CIEDs) include pacemakers, implantable cardioverter defibrillators (ICDs), and loop recorders. Depending on the patient and device, follow-up may combine in-clinic visits with remote monitoring. Remote transmission can help clinical teams review device function and identify actionable alerts between visits; it does not remove the need for individualized clinical assessment. 

Clinical studies have identified potential benefits of remote monitoring, such as earlier detection of actionable device alerts and fewer routine office visits for some patients. The magnitude of benefit depends on the study population, device, follow-up protocol, and clinical circumstances. Historical percentages should not be presented as universal improvements in survival, quality of life, hospital stays, or cost.

During the early COVID-19 pandemic, concern about visits to healthcare facilities increased interest in remote cardiac device monitoring as an adjunct to appropriate in-person care. 

The financial case for remote monitoring
Medicare billing for cardiac device follow-up uses applicable procedure coding, including Current Procedural Terminology (CPT) codes. CPT is maintained by the American Medical Association; coverage and payment depend on the service, payer, setting, and applicable year. See the AMA’s CPT coding overview. The original July 2020 article cited illustrative reimbursement amounts of $49 versus $56 for pacemaker monitoring and $66 versus $64 for ICD monitoring. Those historical figures are not current Medicare payment rates and should not be used to determine reimbursement. 

The 2008 Heart Rhythm Society/European Heart Rhythm Association Expert Consensus on Monitoring CIED set international guidelines for minimum device follow-up frequency, though they vary depending on ICD, pacemaker, and implantable loop recorders (ILRs). Health care providers often choose to perform follow-up visits after device implantation every three to six months for pacemakers and ICDs. For RM and IC checks of pacemakers and ICDs, monitoring periods for reimbursement are set up for 90 day periods and can be charged up to four times per year. With ILRs and cardiac resynchronization therapy (CRT) monitoring for heart failure, separate codes have been established that are based on charging for reimbursement every 30 days.