Currentmoda_health_plan_incPolicy N/A

Mobile Outpatient Cardiac Telemetry (MOCT)

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Policy governs medical necessity and coverage criteria for Mobile Outpatient Cardiac Telemetry (MOCT/MCT) for members of Moda Health Plan Inc., including required documentation and applicable CPT/ICD-10 codes.

Policy Summary

Payermoda_health_plan_inc

PolicyMobile Outpatient Cardiac Telemetry (MOCT)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 1, 2026

Last ReviewApr 22, 2026

Next Review DateApr 22, 2026

Key ActionSubmit prior authorization with chart notes documenting indications and previous Holter or event monitor reports.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Up to 30 daysmonitoring duration

93228, 93229covered CPT codes

I44-I49, R42, R55example ICD-10

Requiredprior auth

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Currentmoda_health_plan_incPolicy N/A

Mobile Outpatient Cardiac Telemetry (MOCT)

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Sign up for all moda_health_plan_inc policy alerts

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Policy Summary

Payermoda_health_plan_inc

PolicyMobile Outpatient Cardiac Telemetry (MOCT)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 1, 2026

Last ReviewApr 22, 2026

Next Review DateApr 22, 2026

Key ActionSubmit prior authorization with chart notes documenting indications and previous Holter or event monitor reports.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Up to 30 daysmonitoring duration

93228, 93229covered CPT codes

I44-I49, R42, R55example ICD-10

Requiredprior auth

Coverage Criteria

Covered when ALL of the following are met

MOCT coverage main criteria: a. Patient has symptoms suggestive of an underlying arrhythmia including but not limited to: i. Pre-syncope and syncope of unknown etiology; or ii. Dizziness or lightheadedness; or iii. Stroke or transient cerebral ischemia, possibly secondary to atrial fibrillation; or iv. Post ablation arrhythmia detection; or v. Evaluation of response to anti-arrhythmic drug therapy. b. Failure to detect arrhythmia with one or more of the following: i. Holter monitor failed to detect arrhythmia during a 24-48 hour period; or ii. Patch type monitor failed to detect arrhythmia for 15 continuous days; or iii. Cardiac event monitor (e.g., external loop recorder) failed to detect an underlying arrhythmia causing the symptoms for 30 continuous days; or iv. The episodes do not last long enough to activate the monitor; or v. The patient is unable to manage the technical requirements of a loop recorder.see node text

All listed subconditions under 'a' and 'b' are required as grouped (symptom requirement AND prior monitor failure/limitation).

The policy does not list any additional exclusion categories beyond the requirement that all coverage criteria be met. In other words, there is no separate exclusion list specified in the document; coverage is determined by whether the patient satisfies the symptom-related criteria and the required prior monitoring failure or limitation described in the criteria set. If those conditions are not met, the request may be denied, but no other explicit exclusions are provided in the policy text.

Use of MOCT is limited to patients who both have symptoms suggestive of an underlying arrhythmia (for example: pre-syncope/syncope of unknown etiology, dizziness/lightheadedness, possible stroke related to atrial fibrillation, post‑ablation arrhythmia surveillance, or evaluation of anti‑arrhythmic therapy) and have experienced a specified failure or limitation of prior non‑MOCT monitoring. The policy states that MOCT is not indicated when a patient does not have the symptom indications or has not had one of the listed monitoring failures (e.g., Holter, patch monitor, or external loop recorder) as described; absence of these required conditions would not meet medical necessity under this policy.

CPT / HCPCS and Diagnosis Codes

Covered CPT/HCPCS CodesCPTCovered

93228

External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real-time data analysis, and greater than 24 hours of accessible ECG data storage (retrievable with a query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with the report by a physician or other qualified health care professional

93229

External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real-time data analysis, and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient-selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional

Covered Diagnosis Codes (ICD-10)ICD-10Covered

I44.0 - I44.7	Atrioventricular and left bundle-branch block
I45.0 - I45.9	Other conduction disorders
I47.1 - I47.9	Supraventricular tachycardia
I48.0 - I48.9	Atrial fibrillation and flutter
I49.1 - I49.8	Atrial premature depolarization
I49.5	Sick sinus syndrome
R42	Dizziness and giddiness
R55	Syncope and collapse

Provider Requirements and Prior Authorization

Prior Authorization

Prior authorization required — include chart notes, prior monitor reports, and CPT codes

Prior authorization is required for MOCT. Requests must include chart notes documenting the indications for MOCT and documentation of previous Holter monitor or event monitor reports. Covered CPT codes for MOCT are 93228 and 93229 (up to 30 days of monitoring).

Include chart notes documenting the clinical indications for MOCT.
Include previous Holter or event monitor reports when available.
Bill using CPT codes 93228 and/or 93229 as applicable.

Step Therapy

Prior monitor failure required before MOCT

MOCT will only be considered after failure to detect arrhythmia with one or more specified non‑MOCT monitors. Acceptable preceding monitor failures include a Holter (24–48 hours), patch monitor (15 continuous days), or cardiac event/external loop monitor (30 continuous days), or situations where episodes are too brief to trigger a monitor or the patient cannot manage a loop recorder.

Holter monitor failed to detect arrhythmia during a 24–48 hour period.
Patch type monitor failed to detect arrhythmia for 15 continuous days.
Cardiac event monitor (external loop recorder) failed to detect arrhythmia for 30 continuous days.
Episodes do not last long enough to activate the monitor, or patient unable to manage technical requirements of a loop recorder.

Documentation Required

Information to include with prior authorization — chart notes and prior monitor reports

Submit chart notes documenting the indications for MOCT and the reports from prior Holter or event monitors with the prior authorization request. These specific items are required to support medical necessity.

Chart notes documenting the clinical indications.
Documentation of previous Holter monitor or event monitor reports.

Denial Risk

Denial risk if symptom criteria or prior monitor failure not documented

Denial risk: MOCT will not meet coverage criteria if ALL required clinical criteria are not documented — specifically absence of symptoms suggestive of arrhythmia or lack of documented failure of preceding monitors may lead to denial.

MOCT is considered only when the patient meets all listed clinical criteria (symptoms plus prior monitor failure/limitations).
Lack of documented symptomatic indications or prior monitor failure/limitations may result in denial.

Background on Mobile Outpatient Cardiac Telemetry

Mobile Outpatient Cardiac Telemetry (MOCT), also referred to as mobile cardiac telemetry, is a wearable monitoring approach intended for ambulatory patients who require prolonged, real‑time rhythm surveillance. This policy frames MOCT use for patients with suspected arrhythmia symptoms who have not had the arrhythmia detected by shorter‑term or event monitors. Covered indications include evaluation of pre‑syncope/syncope of unknown cause, dizziness/lightheadedness, suspected cardioembolic stroke related to atrial fibrillation, post‑ablation arrhythmia detection, and assessment of response to anti‑arrhythmic drugs. The policy requires that MOCT be considered only after one or more specified monitoring failures or limitations—such as a non‑diagnostic 24–48 hour Holter, a patch monitor without detection over 15 continuous days, an external loop recorder without detection over 30 continuous days, episodes too brief to trigger an event monitor, or inability of the patient to manage a loop recorder—are documented.

Definitions

MOCT / MCT — key properties of the technology

DefinitionMobile outpatient cardiac telemetry (MOCT) or mobile cardiac telemetry (MCT) is a small sensor and monitor worn during daily activities that continuously measures heart rate and rhythm with extended memory and real-time transmission to a central surveillance center.

Key capabilityContinuous measurement of heart rate and rhythm over several days with extended memory, enabling detection of cardiac events even when the patient is asymptomatic.

Data handlingRecordings are transmitted to a central surveillance center for real-time computerized analysis and potential initiation of anti-arrhythmic treatment.

Clinical advantageDemonstrated higher diagnostic yield versus standard loop event monitors (example: randomized trial showing 88% diagnostic rate with MOCT vs 75% with loop recorder over up to 30 days).

Typical monitoring durationDesigned for multi-day monitoring and has been evaluated in studies monitoring patients for up to 30 days.

Mobile Outpatient Cardiac Telemetry (MOCT)

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Mobile Outpatient Cardiac Telemetry (MOCT)

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Coverage Criteria for MOCT / MCT

CPT / HCPCS and Diagnosis Codes

Provider Requirements and Prior Authorization

Background on Mobile Outpatient Cardiac Telemetry

Definitions