ModifiedUnitedHealthcarePolicy MMP109.18

Ambulatory Electrocardiographic (AECG) Monitoring

Policy governing clinical indications, coding, and coverage guidance for ambulatory electrocardiographic monitoring devices (Holter, event monitors, patch recorders, external loop recorders, mobile telemetry, and implantable loop recorders) for UnitedHealthcare members.

Policy Summary

PayerUnitedHealthcare

PolicyAmbulatory Electrocardiographic (AECG) Monitoring

Policy CodePolicy MMP109.18

Change TypeCode additions and mapping revisionsreferral wording updated

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionDocument appropriate clinical documentation (12‑lead ECG, history, exam) and link billed CPT codes to an applicable ICD-10 diagnosis when requesting AECG services.

SourceLink

POLICY UPDATE CHANGES

Replaced prior referral instruction with updated referral language to the UnitedHealthcare Commercial Medical Policy on Implantable Loop Recorders and Wearable Heart Rhythm Monitors for coverage guidance for implantable loop recorders.

Added CPT codes 0937T, 0938T, 0939T, and 0940T to the list of applicable codes.

Removed diagnosis codes I20.8, I24.8, and I47.1 from the list of diagnoses applicable to a set of CPT codes.

Added an extensive list of ICD-10 diagnosis codes as applicable codes for policy coverage.

Added list of applicable codes including numerous ICD-10 diagnosis codes (e.g., G45.3, I20.0, I21.01, I25.10, I42.0, I44.0, I47.0, I48.0, I49.01, I63.9, Q20.3, R00.0, R42, R55, Z86.73, Z86.74).

Updated Clinical Evidence and References sections to reflect the most current information.

Archived previous policy version MMP109.17.

30+CPT/HCPCS/ICD-10 codes listed

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.

24-48hRecommended monitor duration

4New temporary CPT codes added

~100+ICD-10 codes added/updated

MMP109.17Previous version archived

Coverage Criteria and Clinical Rationale

inv-01: Covered Indications

AECG monitoring with an FDA-cleared device will be considered reasonable and necessary when ANY of the following clinical situations apply:

Indications for AECG: Patients with unexplained syncope, near syncope, vertigo (dizziness), chest pain, palpitations, and/or dyspnea; nocturnal arrhythmias; to assess documented or suspected bradycardia; to assess average heart rate and adequacy of rate control in atrial fibrillation; to evaluate response to initiation, revision, or discontinuation of arrhythmic drug therapy; to detect arrhythmias post ablation procedures; to evaluate prognosis following Acute Coronary Syndrome; pre/post implantable cardiac defibrillator reprogramming; to assess for Silent Myocardial Ischemia in known or suspected coronary heart disease; to assess for asymptomatic ventricular premature beats or non-sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, dilated or restrictive cardiomyopathy, congenital heart disease, or Brugada syndrome; to evaluate for occult atrial fibrillation as a potential cause of cardio-embolism in patients with cryptogenic stroke

List extracted verbatim from LCD/LCA guidance

inv-02: General coverage considerations

Covered when monitoring modality and duration are clinically indicated to detect arrhythmia (particularly AF) after stroke/TIA, post-cardiac events, or for symptomatic evaluation; select modality and duration based on symptom frequency, clinical context, and device/monitoring capabilities.

Evidence-supported considerations: Providers should order the monitoring modality and duration most appropriate for the patient based on clinical evaluation, symptom frequency, and the device's labeled indications; a 24–48 hour monitor is most appropriate for daily or near‑daily symptoms24-48 hours for daily/near-daily symptoms

From LCD/LCAs: choose modality by symptoms

Extended monitoring to increase AF detection: Longer monitoring periods (e.g., >=7 days and commonly 14–30 days for patch/continuous monitors) increase AF detection yield; consider extended noninvasive monitoring (patch/MCOT) before implantable monitors in patients able to comply with daily useduration >=7 days suggested

Derived from Jiang et al. and systematic reviews showing detection increases with longer monitoring

When to consider implantable monitoring: If noninvasive monitoring (e.g., MCOT or patch) fails to detect AF after an adequate trial (for example, one month of daily-capable MCOT) or if compliance/technical limitations exist, consider an implantable cardiac monitor (ICM/ILR)consider ICM after ~1 month MCOT without detection

inv-03: Guideline-based coverage considerations

Coverage and clinical recommendations summarized from multiple guidelines and evidence:

AAN guideline (cryptogenic stroke): Outpatient cardiac rhythm monitoring with a nonimplanted device is recommended in patients with recent cryptogenic stroke to detect unsuspected non‑valvular AF; longer monitoring periods (one or more weeks) are associated with greater yield (Level C)

AAN practice guideline

ACC/AHA/ACCP/HRS guidance (ICM reasonable): For patients with systemic thromboembolism without known AF where maximal sensitivity is sought, an implantable cardiac monitor (ICM) is reasonable; in stroke/TIA of undetermined cause initial and, if needed, extended monitoring with an implantable loop recorder is reasonable to improve AF detection (Strength 2A, Evidence B)

ACC/AHA/ACCP/HRS guideline summaries

ESC stroke monitoring recommendation: Short-term ECG recording for at least the first 24 hours followed by continuous ECG monitoring for at least 72 hours is recommended whenever possible in acute ischemic stroke/TIA; consider prolonged monitoring in selected patients (Class 1B and IIa)>=24 hours then >=72 hours continuous

Devices that do not have FDA clearance and any 24-hour monitoring station that does not meet the policy Definitions section are considered not reasonable and necessary and may be denied.

This portion of the policy does not list explicit service exclusions; it provides applicable CPT and ICD-10 codes to support claims and documentation for ambulatory ECG monitoring (examples include CPT Codes 93224–93227 and the associated diagnosis codes listed in this section).

The applicable diagnosis code listings in this section (detailed ICD‑10 codes for ischemic heart disease, cardiomyopathies, conduction disorders, syncope, etc.) are provided to support coding and medical necessity documentation and do not by themselves state coverage exclusions.

The SEARCH‑AF trial excluded patients with prolonged in‑hospital atrial fibrillation lasting ≥ 24 hours and those with extended hospital stays; therefore the trial results may have limited generalizability to cardiac surgery patients who had longer in‑hospital AF or prolonged admissions.

When suspicion for ventricular arrhythmia is high and prompt diagnosis or prevention is required, outpatient ambulatory monitoring is inappropriate; urgent in‑hospital evaluation and management are indicated rather than outpatient AECG.

Coverage for any service is ultimately determined by the member's specific benefit plan document, which identifies covered and excluded services and supersedes this policy if there is a conflict; providers should verify individual member benefits.

Use of devices that do not have FDA clearance and use of any 24‑hour monitoring station that does not meet the policy's Definitions are explicitly identified as not reasonable and necessary and may be denied.

In the sections cited here there are no explicit statements labeling specific services as 'Not Medically Necessary'; the content focuses on applicable CPT and ICD‑10 code listings to support documentation and claims.

The document highlights uncertainty about whether detection of additional post‑operative AF (POAF) after discharge translates into improved clinical outcomes such as reduced stroke or mortality and recommends further study before assuming treatment benefit.

The HRS/ISHNE consensus notes that use of AECG monitoring for neurological and muscular diseases is controversial, indicating limited or conditional utility of AECG in these indications and that selection of monitor type should consider diagnostic power, symptom frequency, and patient factors.

Applicable Procedure and Diagnosis Codes

Event Monitor (CPT)CPT

93268	External patient auto-activated event recording with remote download capability up to 30 days; includes transmission, review and interpretation
93270	External event recording with auto-activation; recording (connection, recording, disconnection)
93271	External event recording; transmission and analysis
93272	External event recording; review and interpretation by physician or qualified health care professional

Holter Monitor (CPT)CPT

93224	External ECG recording up to 48 hours; includes recording, scanning analysis with report, review and interpretation
93225	External ECG recording up to 48 hours; recording (connection, recording, disconnection)
93226	External ECG recording up to 48 hours; scanning analysis with report
93227	External ECG recording up to 48 hours; review and interpretation by physician or qualified health care professional

Implantable Loop Recorder (CPT)CPT

33285

Insertion, subcutaneous cardiac rhythm monitor, including programming

Outpatient Cardiac Telemetry (CPT)CPT

93228	External mobile cardiovascular telemetry with real-time analysis and >24 hours ECG data storage; review and interpretation up to 30 days
93229	Technical support, patient instructions, attended surveillance, analysis and transmission of daily and emergent data

Patch / Extended Wear (CPT / Temporary)CPT

93241	External ECG recording >48 hours up to 7 days; includes recording, scanning analysis with report, review and interpretation
93242	External ECG recording >48 hours up to 7 days; recording (connection and initial recording)
93243	External ECG recording >48 hours up to 7 days; scanning analysis with report
93244	External ECG recording >48 hours up to 7 days; review and interpretation
93245	External ECG recording >7 days up to 15 days; includes recording, scanning analysis with report, review and interpretation
93246	External ECG recording >7 days up to 15 days; recording (connection and initial recording)
93247	External ECG recording >7 days up to 15 days; scanning analysis with report
93248	External ECG recording >7 days up to 15 days; review and interpretation
0937T	External ECG recording >15 days up to 30 days; includes recording, scanning analysis with report, review and interpretation (Effective 01/01/2025)
0938T	External ECG recording >15 days up to 30 days; recording (including connection and initial recording) (Effective 01/01/2025)

1–10 of 12

1/2

HCPCSHCPCS

Implantable cardiac event recorder with memory, activator, and programmer (HCPCS code referenced in policy source)

Selected ICD-10 Diagnoses (referenced)ICD-10

G45.0	Vertebro-basilar artery syndrome
G45.1	Carotid artery syndrome (hemispheric)
G45.2	Multiple and bilateral precerebral artery syndromes
G45.3	Amaurosis fugax
G45.8	Other transient cerebral ischemic attacks and related syndromes
G45.9	Transient cerebral ischemic attack, unspecified
G90.01	Carotid sinus syncope
I20.0	Unstable angina
I20.1	Angina pectoris with documented spasm
I20.81	Angina pectoris with coronary microvascular dysfunction

1–10 of 11

1/2

CPT 93224-93227CPT

93224	External ECG recording up to 48 hours; includes recording, scanning analysis with report, review and interpretation
93225	External ECG recording up to 48 hours; recording (connection, recording, disconnection)
93226	External ECG recording up to 48 hours; scanning analysis with report
93227	External ECG recording up to 48 hours; review and interpretation by physician or qualified health care professional

CPT 93228-93229, 93268, 93270-93272CPT

93228	External mobile cardiovascular telemetry with real-time analysis and >24 hours ECG data storage; review and interpretation up to 30 days
93229	Technical support and attended surveillance for mobile cardiovascular telemetry
93268	External auto-activated event recording with remote download capability up to 30 days; includes transmission, review and interpretation
93270	Event recording; recording component
93271	Event recording; transmission and analysis
93272	Event recording; review and interpretation

CPT 93241-93248CPT

93241	External ECG recording >48 hours up to 7 days; includes recording, scanning analysis with report, review and interpretation
93242	External ECG recording >48 hours up to 7 days; recording (connection and initial recording)
93243	External ECG recording >48 hours up to 7 days; scanning analysis with report
93244	External ECG recording >48 hours up to 7 days; review and interpretation
93245	External ECG recording >7 days up to 15 days; includes recording, scanning analysis with report, review and interpretation
93246	External ECG recording >7 days up to 15 days; recording (connection and initial recording)
93247	External ECG recording >7 days up to 15 days; scanning analysis with report
93248	External ECG recording >7 days up to 15 days; review and interpretation

Selected ICD-10 Diagnosis Codes (mixed list)ICD-10

I46.9	Cardiac arrest, cause unspecified
I47.10	Supraventricular tachycardia, unspecified
I47.20	Ventricular tachycardia, unspecified
I47.9	Paroxysmal tachycardia, unspecified
I49.40	Unspecified premature depolarization
R00.0	Tachycardia, unspecified
R00.1	Bradycardia, unspecified
R00.2	Palpitations
R55	Syncope and collapse
R42	Dizziness and giddiness

Referenced CPT Codes (93241-93248)CPT

93241	External ECG recording >48 hours up to 7 days; includes recording, scanning analysis with report, review and interpretation
93242	Recording component for >48 hours up to 7 days
93243	Scanning analysis with report for >48 hours up to 7 days
93244	Review and interpretation for >48 hours up to 7 days
93245	External ECG recording >7 days up to 15 days; includes full service
93246	Recording component for >7 days up to 15 days
93247	Scanning analysis with report for >7 days up to 15 days
93248	Review and interpretation for >7 days up to 15 days

CPT Category III (Temporary) CodesCPT

0937T	External ECG recording >15 days up to 30 days; includes recording, scanning analysis with report, review and interpretation (Effective 01/01/2025)
0938T	Recording component for >15 days up to 30 days (Effective 01/01/2025)
0939T	Scanning analysis with report for >15 days up to 30 days (Effective 01/01/2025)
0940T	Review and interpretation for >15 days up to 30 days (Effective 01/01/2025)

Applicable ICD-10 Diagnosis Codes (detailed list)ICD-10Covered

I20.0	Unstable angina
I21.4	Non-ST elevation (NSTEMI) myocardial infarction
I25.6	Silent myocardial ischemia
I42.0	Dilated cardiomyopathy
I44.2	Atrioventricular block, complete
I45.81	Long QT syndrome
I46.2	Cardiac arrest due to underlying cardiac condition
I46.8	Cardiac arrest due to other underlying condition
I46.9	Cardiac arrest, cause unspecified
I47.10	Supraventricular tachycardia, unspecified

History / Status CodesICD-10

Z86.73	Personal history of TIA and cerebral infarction without residual deficits
Z86.74	Personal history of sudden cardiac arrest

Provider Responsibilities, Prior Authorization, and Documentation

Prior Authorization

Applicable procedure codes (may require prior authorization)

Applicable procedure codes (may require prior authorization): The following CPT/HCPCS codes are recognized as applicable to Ambulatory Electrocardiographic (AECG) monitoring and may be subject to benefit and prior authorization review per the member's plan. Providers should verify member benefit documents and any delegate prior authorization processes prior to service.

CPT codes include (non‑exhaustive list shown in policy): 93224–93229, 93241–93248, 93268, 93270, 93271, 93272, and the extended monitoring codes effective 01/01/2025: 0937T, 0938T, 0939T, 0940T.
HCPCS: implantable cardiac event recorder codes as listed in the policy code tables.
Additions and removals of applicable codes are reflected in Policy History; confirm current effective codes before billing.

Prior Authorization

CPT-to-ICD-10 mapping for authorization

CPT-to-ICD-10 mapping for authorization: Prior authorization and medical necessity review may reference mappings between CPT code groups for AECG monitoring and the ICD-10 diagnoses listed in this policy. Documentation submitted for authorization should include an appropriate diagnosis code that corresponds to the service requested.

Definitions and Device Types

AECG devices

Included device typesHolter monitors, event recorders/monitors, patch recorders, external loop recorders, mobile cardiovascular telemetry/outpatient telemetry, and insertable cardiac monitor/implantable loop recorders

Differentiating featuresDevices differ by intermittent vs continuous recording, patient activation, number of leads, duration, and real-time vs retrospective interpretation

Use case implicationSelect device based on symptom frequency, monitoring duration needed, and device labeled indications

CPT groups (AECG)

CPT code groupingsCPT groups referenced include 93224–93227, 93228–93229, 93241–93248, 93268, and 93270–93272 corresponding to different monitoring types/durations

Mapping to ICD-10

Background and Evidence Summary

Ambulatory ECG monitoring records heart rhythm during a patient’s usual daily activities and can detect clinically significant rhythm disturbances that may be missed on an in‑clinic 12‑lead ECG. Devices differ by recording mode (intermittent vs continuous), lead configuration, duration of monitoring, and whether interpretation is real‑time or retrospective; device selection should align with symptom frequency and diagnostic needs.

Policy Revision History and Changes

2025-09-01material_revisionLatest

Operational referral wording updated to direct readers to the UnitedHealthcare Commercial Medical Policy on Implantable Loop Recorders and Wearable Heart Rhythm Monitors for clinical coverage guidance; CPT Category III temporary codes 0937T–0940T were added; select diagnosis codes (I20.8, I24.8, I47.1) were removed from specific CPT group mappings.

material_revision

Extensive lists of ICD-10 diagnosis codes were added to the applicable diagnosis code mappings (multiple codes enumerated in Policy History/Revision Information and Summary of Changes).

Policy Summary

PayerUnitedHealthcare

PolicyAmbulatory Electrocardiographic (AECG) Monitoring

Policy CodePolicy MMP109.18

Change TypeCode additions and mapping revisionsreferral wording updated

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionDocument appropriate clinical documentation (12‑lead ECG, history, exam) and link billed CPT codes to an applicable ICD-10 diagnosis when requesting AECG services.

SourceLink

On This Page

Based on Jiang et al. findings and recommendations

Device and monitoring station requirements: Monitoring must be performed with an FDA‑cleared device; use of devices without FDA clearance or any 24‑hour monitoring station that does not meet policy definitions is not reasonable and necessary

FDA clearance and monitoring station requirements per LCD/LCA

Modality selection by symptom frequency (ACC/AHA/HRS): For daily symptoms, 24–48 hour Holter is appropriate; less frequent symptoms warrant prolonged ambulatory monitoring or implantable monitors if noninvasive testing is nondiagnostic (Level B‑NR)symptom frequency guides modality

ACC/AHA/HRS bradycardia/syncope guidance

Prolonged monitoring increases AF detection (evidence summary): Systematic reviews and trials show that seven days of AECG monitoring has among the greatest arrhythmia detection for noninvasive durations and that overall AF detection after ischemic stroke/TIA is variable (~11.5% pooled), increasing with longer monitoring and in cryptogenic populations

Kishore et al., Jiang et al., and aggregate evidence

CPT 93224–93227: supported by listed cerebrovascular, congenital cardiac, arrhythmia, dyspnea, and procedural complication diagnoses (examples: I63.*, Q20.*, R00.*, R06.*).
CPT 93241–93248 and 0937T–0940T: supported by transient ischemic attack/embolic stroke diagnoses (G45.*), syncope (G90.01, R55), angina/ACS (I20.*, I21.*), conduction disorders and arrhythmias (I44.*, I45.*, I47.*, I48.*), and other listed codes in the policy.
Ensure the billed CPT code is linked to an applicable ICD-10 diagnosis documented in the medical record.

Prior Authorization

CPT group prior authorization linkage

CPT group prior authorization linkage: Use of the CPT/T codes in each group is tied to the diagnosis codes enumerated in the policy. Prior authorization reviewers will reference these mappings when assessing medical necessity.

Claims for CPT 93241–93248 and 0937T–0940T should include one of the policy's listed diagnosis codes that justify the extended monitoring duration.
If diagnosis coding is omitted or does not match policy mappings, prior authorization may be delayed or denied.

Note

Medicare LCD/LCA references

Medicare LCD/LCA references: Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) related to Ambulatory Electrocardiographic (AECG) Monitoring and Cardiac Event Detection are listed in this policy and reflect local Medicare coverage guidance. Providers should consult the Medicare Coverage Database and the MAC-specific LCD/LCA for their jurisdiction.

See the policy's CMS-related documents table for specific LCD/LCA titles and contractor names.
If an applicable NCD/LCD/LCA exists for the service in the patient’s jurisdiction, compliance with that Medicare guidance is required.

Note

Refer to commercial policy for ICM coverage guidance

Refer to commercial policy for ICM coverage guidance: For guidance on implantable loop recorders (ILR/ICM), refer to the UnitedHealthcare Commercial Medical Policy titled 'Implantable Loop Recorders and Wearable Heart Rhythm Monitors' for clinical coverage guidance when local Medicare documents are silent.

This Medicare Advantage policy directs providers to the referenced UnitedHealthcare Commercial Medical Policy for clinical coverage guidance for implantable loop recorders.
Commercial policy guidance may inform clinical expectations but member-specific benefit documents control coverage determinations.

Note

No explicit authorization or denial triggers stated

No explicit authorization/denial triggers stated: The policy enumerates applicable CPT and ICD-10 codes and mappings but does not define single explicit automatic authorization or denial triggers. Prior authorization decisions will be based on documented medical necessity, applicable LCD/LCA/NCD guidance, and member benefits.

Documentation linking the CPT code to an appropriate diagnosis and clinical rationale is required for authorization review.
Absence of required documentation or mismatched coding may lead to denial or request for additional information.

Documentation Required

Diagnosis-coding linkage

Diagnosis-coding linkage: Claims for AECG services should be submitted with an ICD-10 diagnosis from the policy’s listed codes that supports medical necessity for the specific CPT code billed.

Examples include cerebrovascular (G45.*), atrial fibrillation and other arrhythmias (I47.*, I48.*), conduction disorders (I44.*, I45.*), syncope (R55), palpitations (R00.2), dyspnea (R06.*), and relevant postprocedural codes (I97.*) as appropriate to the service.
Providers must ensure the diagnosis recorded in the claim matches the clinical documentation and the reason for monitoring.

Note

Medicare coverage cross-check

Medicare coverage cross-check: After checking the policy’s LCD/LCA table and the Medicare Coverage Database, if no applicable NCD, LCD, or LCA is found for a given use, apply the Coverage Rationale criteria in this policy to support medical necessity.

Use CMS guidance where available; where hospital/jurisdiction-specific LCDs do not exist, follow the policy's Coverage Rationale and documentation requirements.
Confirm MAC jurisdiction (listed in policy) when checking for local coverage guidance.

Denial Risk

Coverage may be affected if claims or coding are incomplete or inconsistent

Coverage may be affected if claims or coding are incomplete or inconsistent: Omission of required diagnosis codes, use of non‑FDA cleared devices, or monitoring stations that do not meet policy definitions may be considered not reasonable and necessary and can result in denial.

Devices without FDA clearance are not reasonable and necessary and may be denied.
Any 24‑hour monitoring station that does not meet policy Definitions may be denied.
Claims must accurately reflect services performed (CPT) and supporting diagnoses (ICD-10); mismatches may trigger audits or denials.

Note

Benefit document supersedes policy

Benefit document supersedes policy: Member‑specific benefit plan documents determine final coverage. In the event of a conflict between this policy and the member’s benefit plan, the benefit plan document controls.

Verify coverage and limitations in the member’s benefit plan or contact customer service on the member ID card for benefit specifics.
This policy is informational and used to support Medicare Advantage coverage decisions, not to override member plan terms.

Documentation Required

Clinical documentation to support AECG

Clinical documentation to support AECG: Prior to ambulatory monitoring, providers should have a standard 12‑lead ECG, a complete cardiac history, and a cardiac exam that do not satisfactorily explain the patient’s symptoms. Documentation should describe the specific symptom(s) prompting monitoring and how the result will affect management.

Indications include unexplained syncope/near syncope, palpitations, chest pain, dyspnea, nocturnal arrhythmias, suspected bradycardia, evaluation of AF rate control, assessment post‑ablation, evaluation after ACS, and evaluation for occult AF after cryptogenic stroke.
Document prior testing (e.g., 12‑lead ECG) and rationale for extended monitoring versus shorter duration testing.

Documentation Required

Code-to-diagnosis linkage; Coding documentation

Code-to-diagnosis linkage and coding documentation: Documentation should clearly support linkage between billed CPT codes (e.g., 93224–93227, 93228–93272, 93241–93248, 0937T–0940T) and the listed ICD-10 diagnoses. Include relevant clinical notes, prior ECG findings, and the treatment decision anticipated from monitoring results.

Attach or retain documentation that substantiates medical necessity (history, exam, prior ECG, symptoms frequency) as this may be requested on audit.
Policy history reflects updates to applicable CPT and ICD-10 lists; ensure claims use the most current codes as noted in policy effective dates.

Note

Policy history indicates updates to lists of applicable CPT and ICD-10 diagnosis codes

Policy history indicates updates to lists of applicable CPT and ICD-10 diagnosis codes: The policy’s revision history documents additions and removals of CPT and diagnosis codes. Providers should confirm they are using current code sets when requesting authorization or submitting claims.

09/01/2025 update: Added CPT 0937T–0940T and numerous diagnosis code changes; review Policy History prior to submission.
Code changes may affect prior authorization requirements and supported diagnoses; verify current policy version and effective date.

Documentation Required

Documentation and claims accuracy

Documentation and claims accuracy: Providers are expected to retain or have access to appropriate documentation to support coverage and to submit accurate claims. UnitedHealthcare may request documentation during review or audit.

Providers are responsible for accurate claims submission using CPT and ICD-10 codes consistent with this policy and the member benefit.
For Medicare Advantage members with delegated utilization management, follow the delegate's prior authorization and documentation processes where applicable.

These CPT groups are mapped to broad sets of ICD-10 diagnoses to support medical necessity and prior authorization

Temporary codes includedNew temporary CPT codes 0937T–0940T are listed for >15 up to 30 day external monitoring

I44.*, I45.*, I47.*, I48.*, I49.*

Arrhythmia/conduction group examplesI44.* (AV block), I45.* (conduction disorders), I47.* (tachycardias), I48.* (atrial fibrillation/flutter), I49.* (other arrhythmias)

Clinical relevanceThese diagnosis groups support medical necessity for AECG monitoring for arrhythmia detection and management

Documentation requirementProviders must document an appropriate ICD-10 diagnosis from the listed codes when billing referenced CPT groups

I20.*, I21.*, I22.*, I24.*, I25.*

Ischemic heart disease examplesI20.* (angina), I21.* (myocardial infarction), I22.* (subsequent MI), I24.* (acute ischemic heart disease), I25.* (chronic ischemic heart disease)

Applicable scenariosUsed to support AECG monitoring for prognosis after ACS, silent ischemia, or other ischemic cardiac presentations

Code-to-procedure linkageThese ICD-10 codes are mapped to CPT groups for authorization and claims reporting

Acute Coronary Syndrome (ACS)

DefinitionApplies to patients with suspicion or confirmation of acute myocardial ischemia or infarction; includes spectrum from atypical chest discomfort to STEMI and cardiogenic shock

Clinical useAECG may be used to evaluate prognosis following ACS and detect silent myocardial ischemia

Guideline linkageACC/AHA/other guidelines reference ACS when considering ambulatory monitoring for ischemic evaluation

Silent Myocardial Ischemia

DefinitionObjective documentation of myocardial ischemia in the absence of angina or anginal equivalents

Relevance to AECGUsed as an indication for monitoring to detect ischemia that may be asymptomatic (silent ischemia) and guide management

Associated codesI25.6 (silent myocardial ischemia) listed among applicable ICD-10 codes

24-Hour Monitoring Station

DefinitionFacility operating 24/7 with a receiving station staffed by EKG technicians who have immediate 24-hour access to a physician to review transmitted data outside set parameters

Policy implicationAny 24-hour monitoring station that does not meet this definition is considered not reasonable and necessary

Denial riskNoncompliant 24-hour monitoring stations may trigger claim denial per policy

Prolonged monitoring

DefinitionMonitoring longer than 24 hours including multi-day external monitors or implantable loop recorders; associated with increased AF detection compared with short-duration monitoring

ExamplesPatch monitors (14 days), MCOT, or ICM/ILR for very prolonged monitoring

CodingCPT groups 93241–93248 and temporary 0937T–0940T cover multi-day and extended durations

Cryptogenic stroke

DefinitionIschemic stroke or TIA without an identified cause; patients may benefit from extended rhythm monitoring to detect occult AF

Clinical recommendationExtended noninvasive monitoring or ICM may be reasonable in cryptogenic stroke to improve AF detection

Evidence basisGuidelines (ACC/AHA/HRS, AHA/ASA) support extended monitoring though optimal duration is still under study

Medicare Advantage Policy

PurposePolicy documents used to support UnitedHealthcare coverage decisions for Medicare Advantage Plans; not a replacement for Medicare source materials

HierarchyWhere conflicts exist, Medicare source materials (statutes, regulations, NCDs/LCDs) supersede this policy

MaintenanceMedicare Advantage Policies are regularly reviewed and may be updated by UnitedHealthcare

Additional ICD-10 codes (I48.91, I48.92, I49.01, I49.02, I49.1, I49.2, I49.3, I49.49, I49.5, I49.8, I5A, I63.9, I97.120, I97.121, I97.190, I97.191, congenital and symptom codes Q20.*, Q21.*, Q24.6, R00.*, R06.*, R07.*, R10.13, R40.4, R42, R55, Z86.73, Z86.74) were listed in the Summary of Changes for policy applicability.

Clinical evidence and references were updated in this policy revision, and the previous policy version MMP109.17 has been archived for reference.