A pacemaker is a medical device used to treat patients with heart disease. According to the national health insurance policy, pacemakers that meet the indications and scope of use can be included in the health insurance catalog. Specifically, the following conditions need to be met: 1. the pacemaker is one of the reimbursable devices in the health insurance catalog; 2. the patient actually has a heart condition and has been medically diagnosed by a specialist; 3. the pacemaker is a necessary adjunctive treatment after the treatment program prescribed by the health insurance; 4. the pacemaker has been applied for and approved for payment by the health insurance prior to its use. When applying for Medicare payment, the patient needs to submit to the hospital the diagnosis certificate, surgical plan or treatment plan, device selection plan and other relevant documents issued by the doctor. The hospital will review and submit the application for payment to the health insurance organization according to the procedure. If it meets the requirements, the medical insurance organization will be paid.
What are the indications for pacemakers? Cardiac pacemakers are indicated for patients with a wide range of arrhythmias, cardiomyopathy, heart failure and other heart conditions. Specifically, these include the following conditions: 1. atrial fibrillation and other tachyarrhythmias; 2. sinus node hypoplasia or impending sinus arrest; 3. bradyarrhythmias that are not responding to or tolerated by medication; 4. complete atrioventricular block or third-degree AV block following myocardial infarction; and 5. severe heart failure with ventricular dilatation and/or reduced ventricular ejection fraction.
Pacemakers can be reimbursed by Medicare, but they need to meet the indications and scope of use specified by Medicare. Patients are required to provide a legitimate diagnosis and surgical or therapeutic plan from their doctor and submit an application according to the procedure. If the requirements are met, the health insurance organization will make payment. Pacemakers are suitable for patients with a wide range of heart conditions, but they need to be selected and used strictly in accordance with the doctor's recommendations.
Legal basis:
Article 26 of the Social Insurance Law of the People's Republic of China (PRC) Article 26: The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.