To order a LifeVest^® wearable cardioverter defibrillator (WCD), you have the choice of using the Medical Order Form, placing a chart order, or placing a verbal order. In each case, documentation must be provided to support the diagnosis and medical necessity of the LifeVest WCD. Specific instructions are provided below.

To place a medical order

Complete the Medical Order Form and fax it to ZOLL. Click on the link below to download the form and instructions.

• Medical Order Form and Instructions (US English)
• ICD-10 Codes for Selected Cardiac Diagnoses
• Fax Cover Page

To place a chart order

Specific information must be provided. View the Chart Order Instructions Pocket Card for instructions.

To place a verbal order

Specific information must be provided. View the Verbal Order Instructions for more information.

The LifeVest wearable cardioverter defibrillator (WCD) is covered by most health plans in the United States, including commercial, state, and federal plans. This list summarizes the types of patient conditions and situations that are covered. The patient's specific health plan coverage policy should be reviewed to determine coverage for prescribing LifeVest.

• Primary prevention (EF ≤35% and MI, NICM, or other DCM), including:
  • After recent MI (Coverage during the 40 day ICD waiting period)
  • Before and after CABG or PTCA (Coverage during the 90 day ICD waiting period)
  • Listed for cardiac transplant
  • Recently diagnosed nonischemic cardiomyopathy (Coverage during the 3 to 9 month ICD waiting period)
  • NYHA class IV heart failure

• Terminal disease with life expectancy of less than 1 year
• ICD indications when patient condition delays or prohibits ICD implantation
• ICD explantation