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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. 
 
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). 
 
The rules say that 
 
        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. 
            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. 
 
        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. 
 
Indications and Limitations of Coverage 
 
B. Nationally Covered Indications 
 The following indications are covered nationally unless otherwise indicated: 
 
    Computer analysis of EKGs when furnished in a setting and under the circumstances required for coverage 
of other EKG services. 
 
    EKG services rendered by an IDTF, including physician review and interpretation. Separate physician 
services are not covered unless he/she is the patients attending or consulting physician. 
 
    Emergency EKGs (i.e., when the patient is or may be experiencing a life-threatening event) performed as a 
laboratory or diagnostic service by a portable x-ray supplier only when a physician is in attendance at the time 
the service is performed or immediately thereafter. 
 
    Home EKG services with documentation of medical necessity. 
 
    Transtelephonic EKG transmissions (effective March 1, 1980) as a diagnostic service for the indications 
described below, when performed with equipment meeting the standards described below, subject to the 
limitations and conditions specified below. Coverage is further limited to the amounts payable with respect to 
the physicians service in interpreting the results of such transmissions, including charges for rental of the 
equipment. The device used by the beneficiary is part of a total diagnostic system and is not considered DME 
separately. Covered uses are to: 
        Detect, characterize, and document symptomatic transient arrhythmias; 
        Initiate, revise, or discontinue arrhythmic drug therapy; or, 
        Carry-out early post-hospital monitoring of patients discharged after myocardial infarction (MI); (only if 
24-hour coverage is provided, see C.5. below). 
 
Certain uses other than those specified above may be covered if, in the judgment of the local Medicare 
Administrative Contractor (MAC), such use is medically necessary. 
 
Additionally, the transmitting devices must meet at least the following criteria: 
 
    They must be capable of transmitting EKG Leads, I, II, or III; and, 
 
    The tracing must be sufficiently comparable to a conventional EKG. 
 
You can find this information in Medicare's National Coverage Determination (NCD): Electrocardiographic 
Services (20.15). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.