UnitedHealthcare Cardiac Event Monitoring Coverage Update

Coverage and Medical Necessity Criteria

Medical necessity per InterQual

Covered when InterQual CP: Procedures, Electrocardiography, Ambulatory (AECG) criteria are met.

InterQual-based medical necessity: Cardiac event monitoring is proven and medically necessary in certain circumstances when the InterQual CP: Procedures, Electrocardiography, Ambulatory (AECG) criteria are satisfied.

Refer to InterQual AECG for specific clinical elements, documentation requirements, and indication logic.

Replacement of Implantable Loop Recorder

Replacement is covered when ALL of the following are met

Replacement ILR criteria: The individual continues to meet the initial clinical criteria for insertion of an implantable loop recorder AND the existing device is beyond its useful life span, is irreparable, or is no longer operating.

Documentation must demonstrate that initial insertion criteria remain met and that the device is nonfunctional or beyond useful life.

Cardiac Self-Monitoring Devices (Consumer-grade)

Not covered — considered not medically necessary

Consumer cardiac monitoring exclusion: Cardiac self-monitoring devices and software applications sold to or used by the general public for home use (including devices that combine an ECG monitor with a personal electronic device and hardware/software for downloading ECG data) are considered convenience items, are unproven, and are not medically necessary due to insufficient evidence of safety and efficacy for identifying cardiac arrhythmias.

Examples include single-lead smartphone or wearable ECG devices and required downloading hardware or software.

Wearable heart rhythm monitors and associated hardware/software purchased for home use (commonly sold as consumer cardiac self-monitoring devices) are expressly excluded from coverage as they are considered convenience items and not medically necessary. Examples include a self-monitoring device that pairs an ECG monitor with a personal electronic device (for example a cellular telephone or watch) and any hardware or software required to download ECG data to a personal computer, tablet, smartphone, or smartwatch. Replacement or provision of these consumer-grade devices and their downloading components is not covered under this policy.

FDA approval alone is not a basis for coverage. FDA-cleared or -approved status is provided for informational purposes only and does not by itself justify payment. Coverage determinations must be based on medical necessity and documented clinical benefit as described elsewhere in this policy.

Cardiac self-monitoring devices and related software that are commercially available to the general public and purchased for home use are considered unproven and not medically necessary due to insufficient high-quality evidence demonstrating safety and efficacy for identifying cardiac arrhythmias. Systematic and evidence reviews referenced in the policy found no consistent demonstration of improved clinical outcomes compared with standard ambulatory monitoring; as a result these consumer-grade devices and the required downloading hardware/software are excluded as convenience items.

Billing Codes and Coding Guidance

Cardiac Self-Monitoring Devices / OtherCPT|HCPCS|mixedNot Covered

0902T	QTc interval derived by augmentative algorithmic analysis of input from an external, patient- activated mobile ECG device.
93799	Unlisted cardiovascular service or procedure.
E1399	Durable medical equipment, miscellaneous.

Event Monitor and Holter Monitor CodesCPTCovered

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 by a physician or other qualified health care professional.
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 by a physician or other qualified health care professional.
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;

Patch-Type and Extended Wear CodesCPTCovered

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	Recording (includes connection and initial recording).
93243	Scanning analysis with report.
93244	Review and interpretation.
93245	External electrocardiographic recording for more than 7 days up to 15 days; includes recording, scanning analysis with report, review and interpretation.
93246	Recording (includes connection and initial recording).
93247	Scanning analysis with report.
93248	Review and interpretation.

Implantable Loop Recorder and Interrogation CodesCPT | HCPCSCovered

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 by a physician or other qualified health care professional, 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 1 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.
E0616	Implantable cardiac event recorder with memory, activator, and programmer.

Outpatient Cardiac TelemetryCPTCovered

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.

93229

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.

FDA product codes referencedmixed

DSI	FDA product code reference for ambulatory ECG devices, cardiac telemetry, or implantable loop recorders
MXD	FDA product code reference for ambulatory ECG devices, cardiac telemetry, or implantable loop recorders
DXH	FDA product code reference for ambulatory ECG devices, cardiac telemetry, or implantable loop recorders; also listed for cardiac self-monitoring devices
DPS	FDA product code reference for cardiac self-monitoring devices
QDA	FDA product code reference for cardiac self-monitoring devices

Monitoring duration thresholds

Up to 48 hoursCPT 93224–93227: external electrocardiographic recording up to 48 hours (includes recording, scanning analysis with report, review and interpretation)

>48 hours to 7 daysCPT 93241–93244: external electrocardiographic recording for more than 48 hours up to 7 days (includes recording, scanning analysis with report, review and interpretation)

>7 to 15 daysCPT 93245–93248: external electrocardiographic recording for more than 7 days up to 15 days (includes recording, scanning analysis with report, review and interpretation)

Up to 30 days event monitoring/telemetryCPT 93268 and CPT 93228: event recording with remote download capability or external mobile cardiovascular telemetry with monitoring and review for up to 30 days (includes transmission, review and interpretation)

Prior Authorization, Documentation, and Provider Responsibilities

Prior Authorization

Prior Authorization May Be Required

Prior authorization may be required per plan rules for insertion, replacement, or removal of implantable loop recorders (ILRs) and for extended ambulatory cardiac monitoring services. Verify member benefits and obtain any required prior authorization before scheduling procedures or shipping devices.

Affected services include ILR insertion (e.g., CPT 33285), ILR removal/replacement (e.g., CPT 33286), extended ambulatory monitors and related professional and technical services (see applicable CPT/HCPCS codes in policy).
Prior authorization rules vary by product and state; follow the member’s plan-specific prior authorization process.

Documentation Required

Use InterQual Criteria and Document Support

Medical necessity determinations for cardiac event monitoring are based on applicable InterQual criteria (InterQual® CP: Procedures, Electrocardiography, Ambulatory). Document clinical findings, symptoms, prior testing, and duration of monitoring needs to demonstrate alignment with InterQual criteria.

Clinical Background

Cardiac arrhythmias vary in presentation from asymptomatic findings to symptoms such as palpitations, dizziness, presyncope, or syncope. Selection of ambulatory electrocardiographic (ECG) monitoring modality and duration depends on the frequency and nature of symptoms and the clinical question to be answered. Accurate ambulatory ECG diagnosis is essential to guide treatment decisions. This policy references InterQual CP: Procedures, Electrocardiography, Ambulatory (AECG) for specific medical necessity criteria and requires documentation that InterQual criteria are met when requesting coverage for ambulatory monitoring services or implantable loop recorder insertion or replacement.

Definitions and Device Classifications

Cardiac Self-Monitoring Devices

DefinitionConsumer-grade, connected electronic devices and/or software applications that members can use without a physician's prescription; these collect physiologic information (eg, ECG, heart rate) and download to a smartphone, smartwatch, personal computer, or tablet for personal use.

Typical featuresWearable or embedded sensors with high processing power and algorithms that generate measurements such as blood pressure, heart rate, and heart rhythm; data may be stored locally or uploaded to consumer apps.

Coverage stanceConsidered not medically necessary for home use and treated as convenience items due to insufficient evidence of efficacy; claims may be denied.

Implantable Loop Recorder

DefinitionA subcutaneously placed device that continuously records the heart's electrical activity and can transmit data to a physician for monitoring; used to detect abnormal heart rhythms and evaluate causes of palpitations or syncope.

Policy Revision History

2025-06-01Policy createdLatest

New medical policy established (effective date 2025-06-01).

OpenPayer

Cardiac Event Monitoring (for Kansas Only)