National Coverage Determination
Back to NCD List
Digoxin Therapeutic Drug Assay
CMS Policy Number: 190.24
Description: A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin.
Digoxin levels may be performed to monitor drug levels of individuals receiving digoxin therapy because the margin of safety between side effects and toxicity is narrow or because the blood level may not be high enough to achieve the desired clinical effect.
Clinical indications may include individuals on digoxin: With symptoms, signs or electrocardiogram (ECG) suggestive of digoxin toxicity
Taking medications that influence absorption, bioavailability, distribution, and/or elimination of digoxin
With impaired renal, hepatic, gastrointestinal, or thyroid function
With pH and/or electrolyte abnormalities
With unstable cardiovascular status, including myocarditis
Requiring monitoring of patient compliance
Clinical indications may include individuals: Suspected of accidental or intended overdose
Who have an acceptable cardiac diagnosis (as listed) and for whom an accurate history of use of digoxin is unobtainable
The value of obtaining regular serum digoxin levels is uncertain, but it may be reasonable to check levels once yearly after a steady state is achieved. In addition, it may be reasonable to check the level if: Heart failure status worsens
Renal function deteriorates
Additional medications are added that could affect the digoxin level
Signs or symptoms of toxicity develop
Steady state will be reached in approximately 1 week in patients with normal renal function, although 2-3 weeks may be needed in patients with renal impairment. After changes in dosages or the addition of a medication that could affect the digoxin level, it is reasonable to check the digoxin level one week after the change or addition. Based on the clinical situation, in cases of digoxin toxicity, testing may need to be done more than once a week.
Digoxin is indicated for the treatment of patients with heart failure due to systolic dysfunction and for reduction of the ventricular response in patients with atrial fibrillation or flutter. Digoxin may also be indicated to treat other supraventricular arrhythmias, particularly with heart failure.
This test is not appropriate for patients on digitoxin or treated with digoxin FAB (fragment antigen binding) antibody.
To review all requirements of this policy, please see:
CMS NCD listing by Chapter
Covered ICD-10 Codes.
.... and many more.
|A18.84||Tuberculosis of heart|
|E00.0||Congenital iodine-deficiency syndrome, neurological type|
|E00.1||Congenital iodine-deficiency syndrome, myxedematous type|
|E00.2||Congenital iodine-deficiency syndrome, mixed type|
|E00.9||Congenital iodine-deficiency syndrome, unspecified|
|E01.8||Oth iodine-deficiency related thyroid disord and allied cond|
|E02||Subclinical iodine-deficiency hypothyroidism|
|E03.0||Congenital hypothyroidism with diffuse goiter|
|E03.1||Congenital hypothyroidism without goiter|
|E03.2||Hypothyroidism due to meds and oth exogenous substances|
Sorry, you need to login or register to view additional sections of this Medicare policy.
Click here for publications catalog.
The content and format of the following files and/or webpages are
copywritten and the property of Wheaton Partners, LLC - dba CodeMap®. All
recipients of these files agree not to distribute, reproduce and/or use the
information contained within, in any manner not expressly agreed upon by the
user and Wheaton Partners, LLC - dba CodeMap®.
All code-pairs and Medicare coverage information are compiled directly from Center for Medicare and
Medicaid Services (CMS) and Medicare Contractor coverage policies. CodeMap®
has made every reasonable effort to ensure the accuracy of the information
contained. However, the ultimate responsibility for correct
coding and claims submission lies with the provider of services. Both CMS and
Medicare contractor coverage policy information may change at any time.
CodeMap® makes no representation, warranty, or guarantee that this compilation
of coverage policy information is error-free or that the use of this information
will result in Medicare coverage and subsequent payment of claims. Final
coverage and payment of claims are subject to many factors exclusively
controlled by CMS and its contractors.