Currentpriority healthPolicy N/A
Electrocardiographic (EKG/ECG) monitoring (Holter and real-time/mobile telemetry)
Reimbursement and billing policy governing coverage, coding, documentation, and billing rules for Holter (up to 48 hours), long-term recorders (up to 15 days), and external mobile cardiac telemetry (up to 30 days) services for Priority Health providers.
Policy Summary
Payerpriority health
PolicyElectrocardiographic (EKG/ECG) monitoring (Holter and real-time/mobile telemetry)
Policy CodePolicy N/A
Change TypeMinor editorial updates and added denial language
Effective DateMar 18, 2025
Next Review DateJun 20, 2025
Key ActionObtain a Pre-Service Organization Determination (PSOD) when Medicare indications do not meet NCD/LCD or specific medical policy.
SourceLink
POLICY UPDATE CHANGES
Added 'Related denial language' section.
Removed 'Applies to' section.
Updated 'Disclaimer' section.
48 hoursmax continuous monitoring for 93224-93227
up to 30 daysmonitoring for 93228-93229
up to 15 dayslong-term recorder duration
1unit per episode for 93228/93229
No TC/26do not use modifier
Coverage criteria and billing rules
Coverage criteria and billing rules
Coverage is conditioned on medical necessity, appropriate documentation, correct coding and modifier use, and setting appropriateness. Authorization may be required.
ALL of the following
- List the diagnosis code(s) indicating the reason for the test
- History and physical documenting evaluation focused on the presenting symptoms and/or need for testing
- An evaluation and management service documenting the symptoms experienced by the patient
ONE of
- A full workup in the past month with initial tests performed and persistent symptoms indicating need for up to 48-hour monitoring or long-term monitoring
- A required change in antiarrhythmic medication, including assessment of complaints, name of medication stopped, and name of new medication
- If testing is referred, documentation of medical necessity may be requested from the referring physician
- IDTFs and suppliers must retain the referring physician's written orders and the identity of the employee setting up the tracing
ALL of the following
- Codes 93224-93227 describe services intended for up to 48 hours of continuous recording
- The physician review date should be used as the date of service when code 93224 is reported for global services
- For continuous recording less than 12 hours, append modifier -52 (reduced services)
- Do not use modifier 26 or TC with these codes
- Only one unit of service should be reported for codes 93224-93227
- No additional EKG monitoring codes may be billed in conjunction with these services
- Services should not be split and billed individually when performed by the same diagnostic testing facility; the interpreting physician should be reported in the notes section of the claim
ALL of the following
- The date of service must be reported as the date the patient was initially placed on the monitor
- A monitoring episode (one to 30 consecutive days) is reported as one unit
- Do not use modifiers TC or 26 with codes 93228-93229
ALL of the following
- Use the POS code for the setting in which the patient received the test (Independent Diagnostic Testing Facility guidance applies)
- Coverage will be considered for services furnished in the appropriate setting to the patient's medical needs and condition
- Authorization may be required (see Provider Manual)
ALL of the following
- Incorrect application of modifiers will result in denials; see Provider Manual for more information
- Priority Health will not reimburse both a wearable patient monitor and a 48-hour monitor for the same dates of service
- Example related denial language: pf0 -Mod 77 required; code was billed in hx by different provider
ALL of the following
- A technician, nurse or physician trained to interpret ECGs and abnormal rhythms must be available to receive transmissions
- Physicians must be available for immediate consultation to review or discuss transmissions with abnormalities or significant symptoms
Codes, units, and episode reporting
Holter monitor (up to 48 hours)CPTCovered
| 93224 | External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional |
| 93225 | External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection) |
| 93226 | external electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report |
| 93227 | External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional |
External mobile cardiac telemetry (up to 30 days)CPTCovered
| 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 query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional (professional component) |
| 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 (technical component) |
Long-term continuous recorders (>48 hours up to 15 days)CPTCovered
| 93241 | External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation |
| 93242 | External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording) |
| 93243 | External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; scanning analysis with report |
| 93244 | External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation |
| 93245 | External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation |
| 93246 | External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; recording (includes connection and initial recording) |
| 93247 | External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; scanning analysis with report |
| 93248 | External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation |
inv-05: Monitoring episode reporting for 93228/93229
Unit reportingOne unit per monitoring episode (one to 30 consecutive days)
Date of serviceReport date of service as the date the patient was initially placed on the monitor
Applicable codesCPT 93228 (professional) and 93229 (technical)
inv-06: Units for 93224-93227
Unit limitationOnly one unit of service should be reported for CPT codes 93224–93227 (represent up to 48 hours)
Duration representedCodes 93224–93227 are intended for up to 48 hours of continuous recording
Modifier guidanceFor continuous recording <12 hours append modifier -52; do not use modifiers 26 or TC with these codes
Authorization, staffing, and operational requirements
Prior Authorization
Prior Authorization / Pre-Service Organization Determination
Prior Authorization (Pre-Service Organization Determination) may be required for services that do not meet Medicare NCDs, applicable local LCDs, or specific Priority Health medical policy. Providers should submit a PSOD per Priority Health Provider Manual guidance prior to performing services when coverage is uncertain.
- Applies when services do not meet an existing NCD, LCD, or specific medical policy
- Follow Priority Health Provider Manual for PSOD submission procedures
- Authorization may be required for services furnished in certain settings (see Provider Manual)
Note
Clinical staffing and availability
A trained technician, nurse, or physician must be available to receive and interpret ECG transmissions associated with covered services. A physician must be available for immediate consultation to review transmissions with abnormalities or when the patient has significant symptoms. Do not bill for both a wearable patient monitor and a 48‑hour monitor for the same dates of service.
- Clinical staff must be trained to interpret ECGs and abnormal rhythms
- Physician availability required for immediate consultation on abnormal transmissions or significant patient symptoms
- Do not bill both wearable patient monitor and 48-hour monitor for same dates of service
Key definitions
inv-09: Cardiac Event Detection (CED)
DefinitionCardiac Event Detection (CED) is a 30-day service for documentation and diagnosis of paroxysmal or suspected arrhythmias.
PurposeUsed to document and diagnose intermittent (paroxysmal) or suspected arrhythmias over a 30-day monitoring period
Related servicesMay be furnished via external mobile cardiac telemetry (up to 30 days) as described in CPT 93228–93229
inv-10: Holter Monitoring
DefinitionHolter Monitoring is a 24-hour wearable EKG monitor that records the patient’s ambient heart rhythm during a full day (24-hour) cycle.
Typical durationDesigned to evaluate rhythm and significant arrhythmias over a full 24-hour period
Coding contextRepresented by CPT codes 93224–93227 for services intended for up to 48 hours (Holter use typically 24 hours)
Policy Summary
Payerpriority health
PolicyElectrocardiographic (EKG/ECG) monitoring (Holter and real-time/mobile telemetry)
Policy CodePolicy N/A
Change TypeMinor editorial updates and added denial language
Effective DateMar 18, 2025
Next Review DateJun 20, 2025
Key ActionObtain a Pre-Service Organization Determination (PSOD) when Medicare indications do not meet NCD/LCD or specific medical policy.
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.