CurrentMolina HealthcarePolicy N/A

Long‑Term ECG Monitoring (Holter, Cardiac Event Detection)

Defines Molina Healthcare's reimbursement policy and medical necessity framework for long‑term ECG monitoring modalities (Holter, Cardiac Event Detection) and who may be affected (Molina providers and members).

Policy Summary

PayerMolina Healthcare

PolicyLong‑Term ECG Monitoring (Holter, Cardiac Event Detection)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMolina may deny, review, audit, and recoup claims that do not meet medical necessity per referenced policy L34636.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30-dayCED service duration

24-hourHolter duration

L34636Referenced policy

12/16/2024Created

08/08/2025Revised

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Medical Necessity and Coverage Criteria

Medical necessity requirement

Coverage requires meeting the medical necessity indications specified in the referenced CMS policy L34636.

Medical necessity indications in CMS policy L34636 (Electrocardiographic (EKG or ECG) Monitoring [Holter or Real‑Time Monitoring]) are met for the requested long‑term ECG monitoring service.

Member's benefit plan allows coverage for the requested service; listing in this policy does not guarantee coverage and benefits should be verified.

Provider has adhered to industry standard coding and billing practices; Molina may deny, review, audit, and recoup claims if medical necessity or coding requirements are not met.

Codes and Coding Guidance

Referenced coding/medical necessity resourcemixed

L34636

CMS article/policy: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real‑Time Monitoring)

Coding disclaimer

Coding disclaimerCodes listed are for reference only; listing does not guarantee coverage. Deleted or inactive codes and codes not effective at time of service may not be eligible for reimbursement. Providers must follow industry-standard coding practices (CPT) and Molina may reject/deny claims and recover payments for improper billing.

Scope of listingListing of a service or device code in this policy does not guarantee coverage; coverage is determined by the member's benefit document.

Code currencyCodes shown may not be all-inclusive; deleted or not-yet-effective codes may be ineligible for reimbursement.

Standards and trademarksMolina adheres to Current Procedural Terminology (CPT®); CPT codes and descriptions are copyrighted by the AMA and included for informational purposes only.

Definitions and Acronyms

Long‑Term ECG Monitoring definition

DefinitionLong-Term ECG Monitoring: diagnostic procedures providing continuous or event-driven recording of ECG while the patient engages in daily activities, including continuous, patient‑demand, or auto‑detection devices.

PurposeProvides information about rhythm disturbances, waveform abnormalities, and frequency of occurrence.

SettingPerformed while patient is engaged in normal daily activities to capture ambulatory cardiac events.

Cardiac Event Detection (CED)

Service duration30-day service.

IndicationUsed for documenting and diagnosing paroxysmal or suspected arrhythmias.

Modality contextFalls under long-term ECG monitoring modalities for ambulatory cardiac event detection.

Holter Monitoring

Duration24-hour (full day) monitoring.

DeviceWearable EKG monitor that records overall rhythm and significant arrhythmias during the monitoring period.

PurposeEvaluates the patient's ambient heart rhythm throughout a full 24-hour cycle to detect rhythm disturbances.

Acronyms

CMSCenters for Medicare & Medicaid Services.

EKGElectrocardiogram.

ECGElectrocardiography.