TL;DR: The Centers for Medicare & Medicaid Services modified NCD 162 governing Medicare coverage of the HIS Bundle Study, effective March 7, 2026. Here's what billing teams need to know before submitting claims.
The HIS Bundle Study — a specialized electrocardiography procedure requiring right heart catheterization — is covered under Medicare's National Coverage Determination 162, but only for a narrow patient population. CMS updated this policy on March 7, 2026, and the coverage criteria remain tightly defined. This policy does not list specific CPT or HCPCS codes, which creates a documentation burden your team needs to address proactively.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Centers for Medicare & Medicaid Services (CMS) |
| Policy | HIS Bundle Study |
| Policy Code | NCD 162 |
| Change Type | Modified |
| Effective Date | 2026-03-07 |
| Impact Level | Medium |
| Specialties Affected | Cardiology, Electrophysiology, Cardiac Catheterization |
| Key Action | Confirm patient eligibility against the three covered indications before billing; do not bill separately for HIS bundle studies performed during concurrent heart catheterization or diagnostic endocardial electrical stimulation |
CMS HIS Bundle Study Coverage Criteria and Medical Necessity Requirements 2026
Medicare coverage under NCD 162 is narrow by design. CMS covers the HIS Bundle Study for exactly three patient categories, and if your patient doesn't fall into one of them, you're looking at a claim denial.
The three covered indications are: patients with complex ongoing acute arrhythmias, patients with intermittent or permanent heart block in whom pacemaker implantation is being considered, and patients who have recently developed heart block secondary to a myocardial infarction. That last criterion — "recently developed" — is the kind of language that invites documentation disputes. Your clinical notes need to establish the temporal relationship between the MI and the heart block clearly.
Medical necessity documentation is everything here. CMS will not reimburse this procedure for routine electrophysiologic evaluation or as a general workup for unexplained syncope. If you can't tie the study directly to one of those three indications, don't bill for it.
There are no prior authorization requirements stated in the NCD, but absence of prior auth doesn't mean absence of scrutiny. MAC-level auditors look at this category closely, and insufficient clinical documentation supporting medical necessity is the most common trigger for post-payment review on procedures like this.
CMS HIS Bundle Study Exclusions and Non-Covered Indications
Two specific scenarios disqualify separate reimbursement for the HIS Bundle Study, and both are clearly articulated in the NCD.
First: when heart catheterization and the HIS Bundle Study are performed at the same time, Medicare covers only one catheterization plus a small additional charge for the study. You cannot bill two separate catheterization procedures. If your charge capture treats them as independent billable events, you're overbilling — and that's a compliance problem, not just a claim problem.
Second: when a HIS bundle cardiogram is obtained as part of a diagnostic endocardial electrical stimulation, no separate charge is recognized for the HIS bundle study. The cardiogram is bundled. Full stop. Billing it separately produces an unbundling denial at best and a fraud-and-abuse flag at worst.
Both of these are the kind of bundling rules that get missed when charge capture is built from template rather than policy. Review your charge master entries and your charge capture workflows against these two scenarios before March 7, 2026.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Complex ongoing acute arrhythmias | Covered | No specific CPT/HCPCS listed in NCD | Medical necessity documentation required |
| Intermittent or permanent heart block — pacemaker implantation being considered | Covered | No specific CPT/HCPCS listed in NCD | Must document pacemaker consideration in clinical notes |
| Recently developed heart block secondary to myocardial infarction | Covered | No specific CPT/HCPCS listed in NCD | Document temporal relationship between MI and heart block explicitly |
| HIS Bundle Study performed concurrently with heart catheterization | Bundled — separate charge not covered | No specific CPT/HCPCS listed in NCD | Only one catheterization covered; small additional charge for study |
| HIS bundle cardiogram obtained during diagnostic endocardial electrical stimulation | Bundled — no separate charge recognized | No specific CPT/HCPCS listed in NCD | Treat as included in the primary procedure |
CMS HIS Bundle Study Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your charge capture before March 7, 2026. Look specifically for scenarios where the HIS Bundle Study is billed as a standalone line item alongside heart catheterization or diagnostic endocardial electrical stimulation. Both of those are bundled scenarios under NCD 162, and duplicate billing creates denial exposure immediately. |
| 2 | Train your electrophysiology coders on the three covered indications. Post them in your coding department. Acute arrhythmias, heart block with pacemaker consideration, and post-MI heart block are the only three covered patient populations. Any other indication means no coverage under this NCD. |
| 3 | Strengthen your clinical documentation templates. Work with your cardiologists and electrophysiologists to ensure procedure notes explicitly state which of the three covered indications applies. "Recently developed heart block secondary to MI" requires documentation of the MI, the timeline, and the clinical relationship — not just a diagnosis code. |
| 4 | Confirm your MAC's local guidance. NCD 162 sets the national floor, but your Medicare Administrative Contractor may have additional Local Coverage Determinations or billing instructions that layer on top. Check your MAC's website for any LCDs that reference HIS bundle procedures. |
| 5 | Flag cases where catheterization and HIS Bundle Study are co-performed. When both happen in the same session, your billing team should be billing one catheterization plus the additional study charge — not two catheterization charges. Build a billing edit or coding flag into your workflow to catch this before claims go out. |
| 6 | If you're uncertain about how NCD 162 interacts with your existing charge master or a specific patient scenario, bring in your compliance officer before submitting. The bundling rules here are specific enough that getting it wrong once is a recoverable error; getting it wrong systematically is an audit risk. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for HIS Bundle Study Under NCD 162
The NCD 162 policy document as updated March 7, 2026, does not list specific CPT, HCPCS, or ICD-10 codes. This is notable and worth flagging with your coding team.
When a national coverage determination doesn't enumerate codes, your coders need to select the appropriate procedure codes based on the clinical documentation and the procedures actually performed. That introduces variability — and variability introduces denial risk.
Contact your MAC directly to confirm which procedure codes they accept for the HIS Bundle Study in claims submitted on or after March 7, 2026. Get that guidance in writing if you can. For cross-reference, CMS points to NCD Manual section 20.12 for additional context on this policy.
No Codes Listed in This NCD
| Code Type | Status |
|---|---|
| CPT | Not specified in NCD 162 |
| HCPCS | Not specified in NCD 162 |
| ICD-10-CM | Not specified in NCD 162 |
Your billing team should work directly with your MAC and your certified coders to identify the appropriate procedure codes for claims submitted under this NCD. Do not assume the codes you're currently using are correct without validating against MAC guidance.
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