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Leadless Cardiac Pacemaker Form

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Leadless Cardiac Pacemaker

Indications

(1) Does the request meet this criterion: Refer to criteria under the Policy section in this medical policy. Medicaid – BeHealthy:? 
(2) Does the request meet this criterion: Refer to criteria under the Policy section in this medical policy. Medicare:? 
(3) Does the request meet this criterion: HNE has adopted National Coverage Determination (NCD) 20.8.4, Leadless Pacemakers. NCD can be found at MCD Search (cms.gov). Policy I. FDA-approved leadless cardiac pacemakers (e.g. The Micra™ VR or Aveir™ single-chamber transcatheter? 
(4) Does the request meet this criterion: The member has symptomatic paroxysmal or permanent high-grade atrioventricular block or symptomatic bradycardia-tachycardia syndrome or sinus node dysfunction (sinus bradycardia or sinus pauses); AND? 
(5) Does the request meet this criterion: The member has ANY of the following significant contraindications precluding placement of conventional single chamber ventricular pacemaker leads such as:? 

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Original Document

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Leadless Cardiac Pacemaker Medical Policy New Policy Effective: October 1, 2025 Policy Number: UM1064POL

Approval Date: 9/9/2025

Line(s) of Business: Commercial
Medicare Advantage
Medicaid (BeHealthy)

Description

Cardiac pacemakers are intended to be used as a substitute for the heart’s intrinsic pacing system to correct cardiac rhythm disorders. By providing an appropriate heart rate and heart rate response, pacemakers can reestablish effective circulation and normal hemodynamics that are compromised by a slow heart rate. Pacemakers vary in system complexity and can have multiple functions as a on the bases of their ability to sense and/or stimulate both the atria and the ventricles.

Transvenous pacemakers (pacemakers with leads or conventional pacemakers) consist of two components: a pulse generator (i.e. battery component) and electrodes (i.e. leads). The pulse generator consists of a power supply and electronics that can provide periodic electrical pulses to trigger the heart. The generator is typically implanted in the infraclavicular region of the anterior chest wall and placed in a pre-pectoral position; in some cases, a subpectoral position is preferred. The unit generates an electrical impulse, which is transmitted to the myocardium via the electrodes affixed to the myocardium to sense and pace the heart as needed. Conventional pacemakers are also referred to as single-chamber or dual-chamber systems. In single-chamber systems, only 1 lead is placed, typically in the right ventricle. In dual-chamber pacemakers, two leads are placed, one in the right atrium and the other in the right ventricle. Single-chamber ventricular pacemakers are more common.

Leadless Cardiac Pacemakers, as name implies are leadless pacing systems, which encapsulate a pulse generator and lead into a single small unit. Like most pacing leads, the tip of the capsule includes a fixation mechanism and a monolithic controlled-release device. The controlled-release device elutes glucocorticosteroid to reduce acute inflammation at the implantation site. Leadless pacemakers have rate-responsive functionality, and current device longevity estimates are based on bench data. Estimates have suggested that these devices may last over 10 years, depending on the programmed parameters. They can be used for either single-chamber (RV) or, in some cases, atrioventricular sequential pacing. They are generally placed via a transfemoral approach; however, in select patients, they have been successfully implanted via transjugular approach. Potential advantages of leadless pacemakers include avoidance of risks associated with intravascular leads in conventional pacemakers (e.g. lead failure, lead fracture, insulation defect, pneumothorax, infections requiring lead extractions and replacements that can result in a torn subclavian vein or the tricuspid valve, and risks of venous thrombosis and occlusion of the subclavian system from the leads), avoidance of risks associated with pocket creation for placement of conventional pacemakers (e.g. infections, erosions, and pain), and an additional option for patients who require

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a single-chamber pacer. Use of a leadless system eliminates such risks with the added advantage that a patient has vascular access preserved for other medical conditions (e.g. dialysis, chemotherapy). Further, a leadless cardiac pacemaker may be more comfortable and appealing because, unlike conventional pacemakers, patients are unable to see or feel the device or have an implant scar on the chest wall. Leadless pacemakers may also be a better option than surgical endocardial pacemakers for patients with no vascular access due to renal failure or congenital heart disease.

 Line of Business

Commercial:

• Refer to criteria under the Policy section in this medical policy.

Medicaid – BeHealthy:

• Refer to criteria under the Policy section in this medical policy.

Medicare:

• HNE has adopted National Coverage Determination (NCD) 20.8.4, Leadless Pacemakers. NCD can be found at MCD Search (cms.gov).

Policy

I. FDA-approved leadless cardiac pacemakers (e.g. The Micra™ VR or Aveir™ single-chamber transcatheter Pacing System) medically necessary when ALL of the following criteria are met:

A. The member has symptomatic paroxysmal or permanent high-grade atrioventricular block or symptomatic bradycardia-tachycardia syndrome or sinus node dysfunction (sinus bradycardia or sinus pauses); AND

B. The member has ANY of the following significant contraindications precluding placement of conventional single chamber ventricular pacemaker leads such as:

  1. History of an endovascular or cardiovascular implantable electronic device (CIED) infection or who are at high risk for infection, OR
  2. Limited access for trans-venous pacing given venous anomaly, occlusion of axillary veins or planned use of such veins for a semi-permanent catheter or current or planned use of an AV fistula for hemodialysis; OR

  3. Presence of a bio-prosthetic tricuspid valve.

    C. Single chamber (right ventricular) transcatheter pacing systems for all other indications other than in criteria above are considered EXPERIMENTAL and INVESTIGATIONAL.

    D. Right atrial single chamber transcatheter pacing systems are considered EXPERIMENTAL and INVESTIGATIONAL for ALL indications.

    E. Dual chamber transcatheter pacing systems are considered NOT MEDICALLY NECESSARY for ALL indications.

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F. Leadless cardiac pacemaker combined with cardiac resynchronization therapy for enhancement of synchronized pacing capabilities are considered EXPERIMENTAL and INVESTIGATIONAL.

G. Leadless pacemaker combined with subcutaneous implantable cardioverter-defibrillator for prevention of sudden cardiac death are considered EXPERIMENTAL and INVESTIGATIONAL.

Policy Guidelines and Definitions

Coding Guidance

Code
Description
PA 33274 Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed No 33275 Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed No 0795T Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; complete system (ie, right atrial and right ventricular pacemaker components)

Not Medically Necessary for Commercial and MassHealth. Covered for Medicare following NCD. 0796T Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right atrial pacemaker component (when an existing right ventricular single leadless pacemaker exists to create a dual-chamber leadless pacemaker system) 0797T Transcatheter insertion of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system) 0801T Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; dual-chamber system (ie, right atrial and right ventricular pacemaker components) 0802T Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right atrial pacemaker component 0803T Transcatheter removal and replacement of permanent dual-chamber leadless pacemaker, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography, right ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed; right ventricular pacemaker component (when part of a dual-chamber leadless pacemaker system)

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Code
Description
PA 0823T Transcatheter insertion of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed

E&I for Commercial and MassHealth. Covered for Medicare following NCD. 0824T Transcatheter removal of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography), when performed 0825T Transcatheter removal and replacement of permanent single-chamber leadless pacemaker, right atrial, including imaging guidance (eg, fluoroscopy, venous ultrasound, right atrial angiography and/or right ventriculography, femoral venography, cavography) and device evaluation (eg, interrogation or programming), when performed

CPT® Copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Note: CPT/HCPCS codes are included for informational purposes and may not be all inclusive. Inclusion or exclusion of a CPT/HCPCS code(s) does not signify or imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member’s specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee of payment. Other policies and coverage determination guidelines may apply.

References

  1. Permanent cardiac pacing: Overview. Literature review current through: July 2025, Topic last updated: July 23, 2025.
  2. Park Y-S, Cha M-J, Cho MS, et al. Triventricular pacing with leadless pacemaker combined with cardiac resynchronization therapy in severe heart failure. Heart Rhythm Case Rep. 2024;10(8):537-540.
  3. Shantha G, Brock J, Singleton MJ, et al. A comparative study of the two leadless pacemakers in clinical practice. J Cardiovasc Electrophysiol. 2023;34(9):1896-1903.
  4. Tong F, Sun Z. Strategies for safe implantation and effective performance of single-chamber and dual- chamber leadless pacemakers. J Clin Med. 2023;12(7):2454.
  5. Singh JP, Rinaldi CA, Sanders P, et al; SOLVE-CRT Investigators. Leadless ultrasound-based cardiac resynchronization system in heart failure. JAMA Cardiol. 2024 Jul 31 [Online ahead of print].
  6. Reddy VY, Neuzil P, Booth DF, et al. Dual-chamber leadless pacing: Atrioventricular synchrony in preclinical models of normal or blocked atrioventricular conduction. Heart Rhythm. 2023;20(8):1146-1155.
  7. Mararenko A, Udongwo N, Pannu V, et al. Intracardiac leadless versus transvenous permanent pacemaker implantation:Impact on clinical outcomes and healthcare utilization. J Cardiol. 2023;82(5):378-387.
  8. Roberts PR, Garweg C, Yue AM, et al. Preclinical cardiac perforation reduction in leadless pacing: An update to the Micra leadless pacemaker delivery system. Pacing Clin Electrophysiol. 2023;46(9):1085-
  10. Vouliotis AI, Roberts PR, Dilaveris P, et al. Leadless pacemakers: Current achievements and future perspectives. EurCardiol. 2023;18:e49.
  11. ElRefai M, Menexi C, Abouelasaad M, et al. A leadless pacemaker matched with a vasovagal syncope: How long can it last? Pacing Clin Electrophysiol. 2022 Jul;45(7):874-884.
  12. Gao F, Kherallah R, Koetting M, et al. Leadless pacemaker with transcatheter aortic valve implantation: A single-center experience. Pacing Clin Electrophysiol. 2023;46(7):615-622.
  13. Garg J, Shah K, Bhardwaj R, et al. Adverse events associated with AveirTM VR leadless pacemaker: A Food and Drug Administration MAUDE database study. J Cardiovasc Electrophysiol. 2023;34(6):1469-1471.

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  1. Wijesuriya N, Elliott MK, Mehta V, et al. Leadless left ventricular endocardial pacing for cardiac resynchronization therapy: A systematic review and meta-analysis. Heart Rhythm. 2022;19(7):1176-1183.
  2. Wu S, Jin Y, Lu W, et al. Efficacy and safety of leadless pacemakers for atrioventricular synchronous pacing: A systematic review and meta-analysis. J Clin Med. 2023;12(7):2512.
  3. Rordorf R, Savastano S, Bontempi L, et al. Leadless pacing in cardiac transplant recipients: Primary results of a multicenter case experience. J Electrocardiol. 2020;60: 33-35.
  4. Russo V, D'Andrea A, De Vivo S, et al. Single-chamber leadless cardiac pacemaker in patients without atrial fibrillation: Findings from Campania Leadless Registry. Front Cardiovasc Med. 2022; 8:781335.
  5. Ngo L, Nour D, Denman RA, et al. Safety and efficacy of leadless pacemakers: A systematic review and meta-analysis. JAm Heart Assoc. 2021;10(13):e019212.
  6. Oliveira SF, Carvalho MM, Adao L, Nunes JP. Clinical outcomes of leadless pacemaker: A systematic review. Minerva Cardioangiol. 2021;69(3):346-357.
  7. Piccini JP, El-Chami M, Wherry K, et al. Contemporaneous comparison of outcomes among patients implanted with a leadless vs transvenous single-chamber ventricular pacemaker. JAMA Cardiol. 2021;6(10):1187-1195.
  8. Okabe T, El-Chami MF, Lloyd MS, et al. Leadless pacemaker implantation and concurrent atrioventricular junction ablation in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2018;41(5):504-510.
  9. Martínez-Sande JL, García-Seara J, Rodríguez-Manero M, et al. The Micra leadless transcatheter pacemaker. Implantation and mid-term follow-up results in a single center. Rev Esp Cardiol (Engl Ed). 2017;70(4):275-281.
  10. Miller MA, Neuzil P, Dukkipati SR, Reddy VY. Leadless cardiac pacemakers: Back to the future. J Am Coll Cardiol.2015;66(10):1179-1189
  11. Neuzil P, Reddy VY. Leadless cardiac pacemakers: Pacing paradigm change. Curr Cardiol Rep. 2015;17(8):68.
  12. Reddy VY, Exner DV, Cantillon DJ, et al; LEADLESS II Study Investigators. Percutaneous implantation of an entirely intracardiac leadless pacemaker. N Engl J Med. 2015;373(12):1125-1135.
  13. Reddy VY, Exner DV, Doshi R, et al; LEADLESS II Investigators. Primary results on safety and efficacy From the LEADLESS II -- Phase 2 worldwide clinical trial. JACC Clin Electrophysiol. 2022;8(1):115-117.
  14. Reddy VY, Knops RE, Sperzel J, et al. Permanent leadless cardiac pacing: Results of the LEADLESS trial. Circulation.2014;129(14):1466-1471.
  15. Reynolds D, Duray GZ, Omar R, et al; Micra Transcatheter Pacing Study Group.. A leadless intracardiac transcatheter pacing system. N Engl J Med. 2016;374(6):533‐541.
  16. Ritter P, Duray GZ, Steinwender C, et al; Micra Transcatheter Pacing Study Group. Early performance of a miniaturized leadless cardiac pacemaker: The Micra Transcatheter Pacing Study. Eur Heart J. 2015;36(37):2510-2519.
  17. Roberts PR, Clementy N, Al Samadi F, et al. A leadless pacemaker in the real‐world setting: The Micra Transcatheter Pacing System post‐approval registry. Heart Rhythm. 2017;14(9):1375-1379
  18. Seriwala HM, Khan MS, Munir MB, et al. Leadless pacemakers: A new era in cardiac pacing. J Cardiol. 2016;67(1):1-5.
  19. Sperzel J, Burri H, Gras D, et al. State of the art of leadless pacing. Europace. 2015;17(10):1508-1513.
  20. St Jude Medical. Nanostim™ Leadless Pacemaker [website}. St. Paul, MN: St. Jude Medical; 2013. Available at: http://www.sjm.com/leadlesspacing/intl/options/leadless-pacing. Accessed January 22, 2015.
  21. Tjong FV, Brouwer TF, Smeding L, et al. Combined leadless pacemaker and subcutaneous implantable defibrillator therapy: Feasibility, safety, and performance. Europace. 2016;18(11):1740-1747.
  22. Tjong FV, Brouwer TF, Koop B, et al. Acute and 3-month performance of a communicating leadless anti tachycardia pacemaker and subcutaneous implantable defibrillator. JACC Clin Electrophysiol. 2017;3(13):1487-1498.
  23. Tjong FV, Knops RE, Udo EO, et al. Leadless pacemaker versus transvenous single-chamber pacemaker therapy: A propensity score-matched analysis. Heart Rhythm. 2018;15(9):1387-1393.
  24. Tjong FV, Reddy VY. Permanent leadless cardiac pacemaker therapy: A comprehensive review. Circulation.2017;135(15):1458-1470.

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  1. Vamos M, Erath JW, Benz AP, et al. Incidence of cardiac perforation with conventional and with leadless pacemaker systems: A systematic review and meta-analysis. J Cardiovasc Electrophysiol. 2017;28(3):336-
  3. Yarlagadda B, Turagam MK, Dar T, et al. Safety and feasibility of leadless pacemaker in patients undergoing atrioventricular node ablation for atrial fibrillation. Heart Rhythm. 2018;15(7):994-1000.
  4. Zucchelli G, Barletta V, Bongiorni MG. Leadless technology: A new paradigm for cardiac pacing? Minerva Cardioangiol.2018;66(1):113-123.
  5. Ahmed FZ, Cunnington C, Motwani M, Zaidi AM. Totally leadless dual-device implantation for combined spontaneous ventricular tachycardia defibrillation and pacemaker function: A first report. Can J Cardiol. 2017;33(8):1066.e5-1066.e7.
  6. Arkles J, Cooper J. The emerging roles of leadless devices. Curr Treat Options Cardiovasc Med. 2016;18(2):14.
  7. Beurskens NE, Tjong FV, Knops RE. End-of-life management of leadless cardiac pacemaker therapy. Arrhythm Electrophysiol Rev. 2017;6(3):129-133.
  8. Bhatia N, El-Chami M. Leadless pacemakers: A contemporary review. J Geriatr Cardiol. 2018;15(4):249-
  10. Boveda S, Lenarczyk R, Haugaa KH, et al. Use of leadless pacemakers in Europe: Results of the European Heart Rhythm Association survey. Europace. 2018;20(3):555-559.
  11. Boveda S, Marijon E, Lenarczyk R, et al. Factors influencing the use of leadless or transvenous pacemakers: Results of the European Heart Rhythm Association prospective survey. Europace. 2020;22(4):667-673.
  12. Breatnach CR, Dunne L, Al-Alawi K, et al. Leadless Micra pacemaker use in the pediatric population: Device implantation and short-term outcomes. Pediatr Cardiol. 2020;41(4):683-686.
  13. Canadian Agency for Drugs and Technologies in Health (CADTH). Leadless pacemakers for the treatment of cardiac arrhythmias. Issues in Emerging Health Technologies. Issue 134. Ottawa, ON: CADTH; March
  15. Cantillon DJ, Dukkipati SR, Ip JH, et al. Comparative study of acute and mid-term complications with leadless andtransvenous cardiac pacemakers. Heart Rhythm. 2018;15(7):1023-1030.
  16. Cantillon DJ, Gambhir A, Banker R, et al. Wireless communication between paired leadless pacemakers for dual-chamber synchrony. Circ Arrhythm Electrophysiol. 2022;15(7):e010909.
  17. Carabelli A, Jabeur M, Jacon P, et al. European experience with a first totally leadless cardiac resynchronization therapy pacemaker system. Europace. 2021;23(5):740-747.
  18. Chieng D, Lee F, Ireland K, Paul V. Safety and efficacy outcomes of combined leadless pacemaker and atrioventricular nodal ablation for atrial fibrillation using a single femoral puncture approach. Heart Lung Circ. 2020;29(5):759-765.
  19. Crossley GH, Piccini JP, Longacre C, et al. Leadless versus transvenous single-chamber ventricular pacemakers: 3-yearfollow-up of the Micra CED study. J Cardiovasc Electrophysiol. 2023;34(4):1015-1023.
  20. Darlington D, Brown P, Carvalho V, et al. Efficacy and safety of leadless pacemaker: A systematic review, pooled analysis and meta-analysis. Indian Pacing Electrophysiol J. 2022;22(2):77-86.
  21. Duray GZ, Ritter P, El‐Chami M, et al; Micra Transcatheter Pacing Study Group. Long‐term performance of a transcatheter pacing system: 12‐month results from the Micra Transcatheter Pacing Study. Heart Rhythm. 2017;14(5):702-709.
  22. Gonzalez Villegas E, Al Razzo O, Silvestre Garcia J, Mesa Garcia J. Leadless pacemaker extraction from a single-center perspective. Pacing Clin Electrophysiol. 2018;41(2):101-105.
  23. Hames R, Hayanga JWA, Schmidt-Krings D, et al. Tricuspid valve replacement in a patient with a leadless cardiac pacemaker: Current guidelines and recommendations for perioperative management. Case Rep Anesthesiol.2021;2021:5559830.
  24. Han JJ. The Aveir leadless pacing system receives FDA approval. Artif Organs. 2022;46(7):1219-1220.
  25. Hayes DL. Permanent cardiac pacing: Overview of devices and indications. UpToDate [online serial]. Waltham, MA: UpToDate; reviewed August 2017.
  26. Higuchi S, Okada A, Shoda M, et al. Leadless cardiac pacemaker implantations after infected pacemaker system removalsin octogenarians. J Geriatr Cardiol. 2021;18(7):505-513.

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  1. Knops RE, Reddy VY, Ip JE, et al; Aveir DR i2i Study Investigators. A dual-chamber leadless pacemaker. N Engl J Med.2023;388(25):2360-2370.
  2. Knops RE, Tjong FV, Neuzil P, et al. Chronic performance of a leadless cardiac pacemaker: 1-year follow- up of theLEADLESS trial. J Am Coll Cardiol. 2015;65(15):1497-1504
  3. Kypta A, Blessberger H, Kammler J, et al. Leadless cardiac pacemaker implantation after lead extraction in patients withsevere device infection. J Cardiovasc Electrophysiol. 2016;27(9):1067-1071.
  4. Lau CP, Lee KL. One stage atrioventricular nodal ablation and leadless pacemaker implantation for refractory atrial fibrillation. J Arrhythm. 2018;35(1):139-141.
  5. Lenarczyk R, Boveda S, Mansourati J, et al. Peri-procedural management, implantation feasibility, and short-term outcomes in patients undergoing implantation of leadless pacemakers: European snapshot survey. Europace.2020;22(5):833-838.

  6. Li Q-Y, Dong J-Z, Guo C-J, et al. Initial studies on the implanting sites of high and low ventricular septa using leadless cardiac pacemakers. Ann Noninvasive Electrocardiol. 2023;28(4):e13068.

    Policy Implementation

    Approved by the Medical and Pharmacy Policy Committee

    Kate McIntosh MD MBA

    Chief Medical Officer

    Saad Usmani MD MBA

    Medical Director

    Date Update 08/2025 New medical policy describing Medically Necessity and Experimental/Investigational indications.

    Medical Criteria Disclaimer

    Property of Health New England. All rights reserved. The treating physician or primary care provider must submit to Health New England the clinical evidence that the patient meets the criteria for the treatment, testing or surgical procedure. Without this documentation and information, Health New England will not be able to properly review the request for prior authorization. The clinical review criteria reflect how Health New England determines whether certain services or supplies are medically necessary. Health New England established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
    Health New England expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by Health New England, as some programs exclude coverage for services or supplies that Health New England considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be

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mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. All coding and web site links are accurate at time of publication. Health New England has adopted the herein policy in providing management, administrative and other services to its Health Plan.

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