Cardiac Event Detection

Effective Date: July 6, 2022

Purpose:

This policy provides guidelines for cardiac event detection services when appropriately billed by professional providers.

Scope:

Products included:

  • NJ FamilyCare/Medicaid
  • MLTSS

Definitions:

  • CPT Code 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
  • CPT Code 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
  • CPT Code 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
  • CPT Code 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)
  • CPT Code 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
  • CPT Code 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

Policy:

In alignment with CMS, it would not be necessary to perform a mobile cardiovascular telemetry (MCT) procedure or external patient activated single or multiple event recording with pre-symptom memory loop test more frequently than once in six months. Therefore, additional billings in excess of once every six (6) months will not be reimbursed.

Performance of this service at greater frequencies is not typically required in virtually all clinical circumstances, and this policy conforms with industry norms.

Cardiovascular Monitoring Service codes included in this policy:

  • 93228
  • 93229
  • 93268
  • 93270
  • 93271
  • 93272

Procedure:

Horizon NJ Health will not consider for reimbursement CPT codes 93228-93229 (External mobile cardiovascular telemetry [MCT]), or 93268-93272 (External patient activated ECG event recording) when billed more than once in a six month period by any provider.

References:

American Medical Association, Current Procedural Terminology (CPT®) Professional Edition and associated publications and services

CMS Local Coverage Determination (LCD) L34953: “Cardiac Event Detection Monitoring” https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=34953&ver=27&bc=0

Limitations and Exclusions:

Notwithstanding the foregoing, all payment determinations are subject to all other, applicable limitations, including but not limited to, the following:

  • Benefit Limitations;
  • The terms of any applicable provider participation agreement;
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic;
  • Medical necessity; and
  • Applicable law, regulatory guidance, government mandates, and the terms of the Managed Care Contract between Horizon NJ Health and the New Jersey Department of Human Services, Division of Medical Assistance and Health Services.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. The CPT codes and nomenclature used in this Policy are subject to revision and/or change by the American Medical Association. In the event of such changes, the Policy will continue to be in force, albeit applied to the new or amended coding so issued until such time as the Policy is reviewed and updated to reflect the new or amended coding.