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Effective Date: 11/01/2011 Title: Cardiac Event Recorder, External Loop Recorder
Revision Date: Document: BI317:00
CPT Code(s): 93268, 93270, 93271, 93272
Public Statement

There are several devices to monitor cardiac rhythm of the ambulatory patient.  Rhythm can be monitored continuously or intermittently by external or implanted devices.  The simplest is the patient-activated event recorder that the patient carries in their pocket or purse.  The patient activates this device at the time of symptoms by placing the recorder against the chest and pressing a button.  This device does not review an asymptomatic event or rhythm before patient activation.

These devices are covered for patients who have symptoms that may indicate cardiac rhythm disturbance, when pre-authorized.


Medical Statement

A pre-symptom memory loop cardiac event recorder meets primary coverage criteria for effectiveness and is covered based on a 30-day period of observation for patients whose symptoms are considered infrequent enough that it would be unlikely that a cardiac arrhythmic event would be captured by a rhythm strip or 24-hour continuous EKG waveform recording and storage or computerized monitoring device.  To properly bill for CPT 93268 or any of the components (CPT 93270, 93271, or 93272), a monitoring service must be available 24-hours per day, 7 days a week, to allow the patient to report any activation of the monitor.  Twenty-four hour coverage means that there must be, at the monitoring site (or sites) an experienced EKG technician receiving calls; tape recording devices do not meet this requirement.  Further, such technicians should have immediate access to a physician, and have been instructed in when and how to contact available facilities to assist the patient in cases of emergencies.

 

This form of EKG monitoring is ordered only by the patient`s physician as part of an overall plan of treatment.  This monitoring is used to record symptomatic episodes of rate disturbance.

 

The patient`s physician must order the monitoring service.  The patient must have seen that physician within one month of initiating of monitoring.  The patient must be symptomatic.

93268

External patient and, when performed, autoactivated ECG rhthym derived event recording...up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation

93270

External patient and, when performed, autoactivated ECG rhthym derived event recording...up to 30 days, 24-hour attended monitoring; recording

93271

External patient and, when performed, autoactivated ECG rhthym derived event recording...up to 30 days, 24-hour attended monitoring; transmission download and analysis

93272

External patient and, when performed, autoactivated ECG rhthym derived event recording...up to 30 days, 24-hour attended monitoring; physician review and interpretation


Limits

This device is not covered when used in clinics, nursing homes, hospitals, ambulatory surgery centers, or other facilities for the routine transmission of electrocardiograms or rhythm strips or monitoring of patients.


Reference

Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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