CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Medical Coverage Policy — Cardiointegram (CIG)

Policy governing coverage of Cardiointegram (CIG) as a diagnostic technique for detecting ECG abnormalities in individuals at risk of cardiac ischemia for Commercial Products (Medicare Advantage addressed separately).

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy — Cardiointegram (CIG)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date02|06|2010

Next Review DateN/A

Key ActionDo not bill HCPCS code S9025 for Commercial Products — Cardiointegram is considered not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessarycoverage stance

Not applicableprior auth

S9025HCPCS

Coverage Criteria — Cardiointegram (CIG)

Commercial Products — Not Medically Necessary

Covered when ALL of the following are met

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy — Cardiointegram (CIG)

Policy CodePolicy N/A

Change TypeNo material change

Effective Date02|06|2010

Next Review DateN/A

Key ActionDo not bill HCPCS code S9025 for Commercial Products — Cardiointegram is considered not medically necessary.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions / Billing Guidance

Prior Authorization

Prior Authorization Required

Prior authorization: Not applicable.

Step Therapy

No step therapy requirements specified.

Documentation Required

Benefit Verification

Benefits may vary between groups and contracts. Refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage and not medically necessary benefits.

Denial Risk

Denial Triggers / Billing Guidance

Cardiointegram (HCPCS S9025) is considered not medically necessary for Commercial Products; billing for S9025 may be denied.

HCPCS: S9025 — Omnicardiogram / cardiointegram (Not medically necessary)

Background

Cardiointegram (CIG) uses a microcomputer that receives output from a standard 12‑lead electrocardiogram (EKG) and transforms it into a graphic representation of the heart's electrophysiologic signals. It is intended to detect ECG abnormalities not identifiable by competent routine interpretation and has been proposed as a substitute for exercise tolerance testing with thallium imaging in certain patients; however, the evidence is insufficient to support its efficacy as a diagnostic tool for cardiac ischemia.

Definitions

Cardiointegram (CIG) — definition

TermCardiointegram (CIG)

DefinitionA technique/device that uses a microcomputer to receive output from a standard 12-lead electrocardiogram (EKG) and transforms it to produce a graphic representation of heart electrophysiologic signals.

Intended useIntended to detect abnormalities in the standard 12-lead ECG that are not identifiable by competent routine interpretation in patients at risk of cardiac ischemia.

Proposed clinical roleMay be used as a substitute for exercise tolerance testing with thallium imaging in patients for whom EKG may be inadequate to identify changes compatible with coronary artery disease.

Coverage stance (Commercial Products)Considered not medically necessary due to insufficient evidence to support its efficacy as a diagnostic tool.

OpenPayer

Medical Coverage Policy — Cardiointegram (CIG)

Coverage Criteria — Cardiointegram (CIG)

Coding

Provider Actions / Billing Guidance

Background

Definitions