1. At the time of initial certification on ongoing: Optimal treatment with diuretics and vasodilators or patient have angina pectoris and resistant to nitrate therapy and not a candidate for invasive procedure
2. Symptoms of CHF at rest: unable to carry on any physical activity, symptoms present at rest, symptoms increased with physical activity

These factors will support eligibility

1. Ejection Fraction < 20%
2. HIV
3. Cardiac arrest/CPR, Syncope or CVA
4. New/symptomatic arrhythmias
5. CHF symptoms or angina at rest on optimal medical Rx

Medicare Local Coverage Determination (LCD) for Cardiopulmonary Disease