UnitedHealthcare cardiac event monitoring Coverage Update

Implantable Loop Recorder Replacement

Replacement of implantable loop recorders is considered medically necessary when ALL of the following apply

Replacement ILR criteria: Individual continues to meet initial criteria for insertion

Refer to initial insertion criteria as described in the policy

Replacement ILR criteria: Existing implantable loop recorder is beyond its useful life span OR is irreparable OR is no longer operating

Device condition must preclude continued safe/effective function

Ambulatory ECG Modality Selection

Covered when monitoring is indicated for diagnosis or management of suspected arrhythmia based on clinical presentation

Ambulatory ECG selection: Type and duration of ambulatory ECG monitoring should be dictated by the frequency of symptoms

Select modality (e.g., Holter, event monitor, patch, mobile telemetry, implantable recorder) based on symptom frequency and clinical judgment

Cardiac self-monitoring devices and smartphone/smartwatch applications that download ECG data to personal devices are considered convenience items and are not medically necessary because of insufficient evidence demonstrating safety and efficacy for identifying cardiac arrhythmias. Examples include hardware or software for downloading ECG data to a personal computer, tablet, or smartphone, and self-monitoring devices that embed an ECG monitor within personal electronics such as a cellular telephone or watch.

Information about Food and Drug Administration (FDA) review or clearance of devices is provided for reference only. FDA approval alone is not a basis for coverage; coverage decisions are determined by medical necessity criteria and applicable plan terms.

Wearable heart rhythm monitors (consumer-grade cardiac self-monitoring devices) purchased for home use, including any required hardware or software to download ECG data and devices embedded in personal electronics, are not medically necessary. These products are considered convenience items due to a lack of quality research showing they reliably identify arrhythmias or improve clinical outcomes compared with established monitoring modalities.

Applicable Codes and Coding Details

Event Monitor and Holter monitor CPT codesCPT

0902T	QTc interval derived by augmentative algorithmic analysis of input from an external, patient-activated mobile ECG device.
93799	Unlisted cardiovascular service or procedure.
93268	External patient and, when performed, auto-activated electrocardiographic rhythm-derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation.
93270	External patient and, when performed, auto-activated electrocardiographic rhythm-derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection).
93271	External patient and, when performed, auto-activated electrocardiographic rhythm-derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis.
93272	External patient and, when performed, auto-activated electrocardiographic rhythm-derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation.
93224	External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation.
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.

Implantable loop recorder and interrogation CPT codesCPTCovered

0650T	Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system, with iterative adjustment of the implantable device to test the function of the device and select optimal permanently programmed values with analysis, review and report by a physician or other qualified health care professional.
33285	Insertion, subcutaneous cardiac rhythm monitor; including programming.
33286	Removal, subcutaneous cardiac rhythm monitor.
93285	Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; subcutaneous cardiac rhythm monitor system.
93291	Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter; subcutaneous cardiac rhythm monitor system, including heart rhythm derived data analysis.
93297	Interrogation device evaluation(s) (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of one or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional.
93298	Interrogation device evaluation(s) (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional.

Outpatient cardiac telemetry CPT codesCPTCovered

93228	External mobile cardiovascular telemetry with ECG recording, concurrent computerized real-time data analysis and >24 hours of accessible ECG data storage with events transmitted to remote attended surveillance center for up to 30 days; review and interpretation with report.
93229	External mobile cardiovascular telemetry with ECG recording; technical support, attended surveillance, analysis and transmission of emergent data reports as prescribed daily.

Patch-type and extended ambulatory monitoring CPT codesCPTCovered

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

HCPCS codesHCPCS

E1399	Durable medical equipment; miscellaneous (used here for cardiac self-monitoring devices).
E0616	Implantable cardiac event recorder with memory, activator; and programmer.

FDA product codes (informational)mixed

DSI	FDA product code referenced for ambulatory ECG devices / telemetry / implantable loop recorders (informational)
MXD	FDA product code referenced for ambulatory ECG devices / telemetry / implantable loop recorders (informational)
DXH	FDA product code referenced for ambulatory ECG devices / telemetry / implantable loop recorders (informational)

Event monitor maximum remote download capability — up to 30 days

Maximum remote download capabilityEvent monitors (CPT 93268, 93270–93272) include remote download capability up to 30 days

Associated CPT codes93268, 93270, 93271, 93272

ContextDescribed under Event Monitor code descriptions as ‘remote download capability up to 30 days’ for 24‑hour attended monitoring

Patch/extended monitoring durations — up to 7 days; up to 15 days

Short-duration patch monitoringExternal ECG recording >48 hours up to 7 days (CPT 93241–93244)

Extended-duration patch monitoringExternal ECG recording >7 days up to 15 days (CPT 93245–93248)

Associated CPT codes93241–93248

Provider Requirements, Prior Authorization, and Billing Guidance

Prior Authorization

Prior Authorization and Modality Selection

Replacement or insertion/removal of subcutaneous cardiac rhythm monitors (implantable loop recorders) is considered medically necessary when criteria are met. Prior authorization requirements may apply; verify the member's plan prior authorization rules before scheduling.

Prior authorization may be required for insertion, replacement, or removal of implantable loop recorders. Check member-specific plan requirements (federal/state/contractual).
Select ambulatory ECG monitoring modality based on symptom frequency and clinical indication.
Before relying on this policy for coverage determinations, verify the applicable federal, state, or contractual benefit plan requirements as they may differ and govern in case of conflict.

Denial Risk

Denial Risk for Consumer-Grade Self-Monitoring Devices

Wearable heart rhythm monitors and consumer-grade self-monitoring devices (including hardware or software that downloads ECG data to personal computers, tablets, smartphones, or smart watches, or devices that combine ECG with a personal electronic device) are considered not medically necessary and are a denial risk when billed as medical monitoring.

Examples include consumer ECG watches, phone-based ECG apps, or hardware required for downloading ECG data for home use.
Document use of clinically validated, FDA-cleared devices when applicable; consumer-grade devices should not be submitted as a substitute for medically indicated ambulatory monitoring.

Billing Rule

Coding and Benefit Determination

Providers should reference the listed procedure and diagnosis codes for billing and benefit determination. Inclusion of a code in this policy is for reference only and does not guarantee coverage or payment; benefit determination is subject to federal, state, or contractual requirements.

Applicable CPT/HCPCS/ICD-10 codes (examples): 33285 (Insertion, subcutaneous cardiac rhythm monitor; including programming), 33286 (Removal, subcutaneous cardiac rhythm monitor), 93285 (Programming device evaluation, in person), 0650T (Programming device evaluation, remote).
Listing of a code does not imply coverage. Confirm benefit and billing rules with the member's plan prior to claim submission.

Note

Verify Plan Terms

This policy assists in interpreting UnitedHealthcare standard benefit plans but does not replace plan-specific terms. Always verify federal, state, or contractual plan terms for the member; those terms govern in the event of any conflict with this policy.

Before using this policy for clinical or billing decisions, check the member's specific plan documents and prior authorization requirements.
UnitedHealthcare may modify policies; use the most current plan and policy information when making coverage decisions.

Definitions and Device Classifications

Cardiac Self-Monitoring Devices — definition

DefinitionConsumer-grade, connected electronic devices and/or software applications that members can use without a physician's prescription to collect physiologic information (ECG, heart rate, blood pressure) and download data to personal devices

Examples of form factorWearable accessories, embedded sensors in clothing, smartphone or smartwatch applications

Intended useHome use for self-monitoring and data download to personal smartphone, smartwatch, tablet or computer

Implantable Loop Recorder — definition

DefinitionA subcutaneously implanted device that continuously records the heart's electrical activity and can transmit data to a physician to help detect abnormal heart rhythms

PlacementInserted under the skin (subcutaneous) for long‑term continuous recording

Clinical purposeUsed to help determine causes of palpitations or syncope by long‑term rhythm monitoring

Mobile cardiac self-monitoring devices (FDA classification)

FDA classificationClass II devices under designation ‘transmitters and receivers, electrocardiograph, telephone’

ScopeClassification applies to mobile cardiac self‑monitoring devices (informational)

Regulatory noteFDA approval alone is not a basis for coverage (informational)

OpenPayer

Cardiac Event Monitoring (for Kansas Only)

Coverage Criteria and Clinical Guidance

Applicable Codes and Coding Details

Provider Requirements, Prior Authorization, and Billing Guidance

Definitions and Device Classifications

Background and Clinical Context

Policy Revision History