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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
1. The rules state that An event monitor, or event recorder, is a patient-activated or event-activated EKG 
device that intermittently records cardiac arrhythmic events as they occur. The EKG is recorded on 
magnetic tape or other digital medium. 
Cardiac event monitor technology varies among different devices. For patient-activated event monitors, 
the patient initiates recording when symptoms appear or when instructed to do so by a physician (e.g., 
following exercise). For self-sensing, automatically triggered monitors, an EKG is automatically 
recorded when the device detects an arrhythmia, without patient intervention. Some devices permit a 
patient to transmit EKG data transtelephonically (i.e., via telephone) to a receiving center where the 
data is reviewed. A technician may be available at these centers to review transmitted data 24 hours per 
day. In some instances, when the EKG is determined to be outside certain pre-set criteria by a 
technician or other non-physician, a physician is available 24 hours per day to review the transmitted 
data and to make clinical decisions regarding the patient. These services are known as 24-hour 
attended monitoring. In other instances, transmitted EKG data is reviewed at a later time and are, 
therefore, considered non-attended. 
Cardiac event monitors without transtelephonic capability must be removed from the patient and taken 
to a location for review of the stored EKG data. Some devices also permit a "time sampling" mode of 
operation. The "time sampling" mode is not covered under ambulatory EKG monitoring technology. 
Some cardiac event monitoring devices with trans-telephonic capabilities require the patient to dial the 
phone number of a central EKG data reception center and initiate transmission of EKG data. Other 
devices use Internet-based in-home computers to capture and store EKG data. When such devices detect 
pre-programmed arrhythmias, data is automatically sent via modem and standard telephone lines to a 
central receiving center, or independent diagnostic testing facility (IDTF), where the data is reviewed. 
Internet-based in-home computer systems may also provide the receiving center with a daily computer-
generated report that summarizes 24 hours of EKG data. 
Certain cardiac event monitors capture electrical activity with a single electrode attached to the skin. 
Other devices may employ multiple electrodes in order to record more complex EKG tracings. Additionally, devices may be individually programmed to detect patient-specific factors, electrode 
malfunction, or other factors. Cardiac event monitors can be further categorized as either pre-event or 
post-event recorders, based on their memory capabilities: 
a. Pre-symptom Memory Loop Recorder (MLR) 
Upon detecting symptoms, the wearer presses a button, which activates the recorder to save (i.e., 
memorize) an interval of pre-symptom EKG data along with data during and subsequent to the 
symptomatic event. Self-sensing recorders (also known as event-activated or automatic trigger) 
do not require patient input to capture these data. Single or multiple events may be recorded. 
The device is worn at all times, usually for up to 30 days. 
o Implantable (or Insertable Loop) Recorder (ILR) 
Another type of pre-symptom MLR, it is implanted subcutaneously in a patients upper left 
chest and may remain implanted for many months. An ILR is used when syncope is thought to 
be cardiac-related but is too infrequent to be detected by either a HolterTM monitor or a 
traditional pre-symptom MLR. 
b. Post-symptom Recorder 
The patient temporarily places this device against the chest when symptoms occur and activates 
it by pressing a button. These recorders represent old technology, as they do not include a 
memory loop. The device transmits EKG data telephonically in real-time and is usually used for 
up to 30 days. 
You can find this rule at the Medicare National Coverage Determination (NCD) 20.15: Electrocardiographic 
Services. 
 
The rules say that medically necessary services are those that are reasonable and necessary for the diagnosis or treatment 
of an illness or injury. Medically necessary services include services to improve the functioning of a malformed body 
member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
 
The rules say that services that are not medically necessary are not covered. The rules also say that experimental and 
investigational devices are not covered. You can find this rule at 42 CFR Sections 411.15 and 411.15(o). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.