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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 the following indications for electrocardiographic (EKG) services are covered nationally 
unless otherwise indicated: 
1. Computer analysis of EKGs when furnished in a setting and under the circumstances required for coverage 
of other EKG services. 
2. 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. 
3. 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. 
4. Home EKG services with documentation of medical necessity. 
5.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: 
 
a. Detect, characterize, and document symptomatic transient arrhythmias; 
b. Initiate, revise, or discontinue arrhythmic drug therapy; or, 
c. Carry-out early post-hospital monitoring of patients discharged after myocardial infarction (MI); (only if 24-
hour coverage is provided) 
 
You can find this rule in the National Coverage Determination (NCD) - Electrocardiographic Service (20.15) - 
Effective December 10, 2004. 
 
The rules say that the following indications are non-covered nationally unless otherwise specified below: 
 
1. The time-sampling mode of operation of ambulatory EKG cardiac event monitoring/recording. 
2. Separate physician services other than those rendered by an IDTF unless rendered by the patients attending 
or consulting physician. 
3. Home EKG services without documentation of medical necessity. 
4. Emergency EKG services by a portable x-ray supplier without a physician in attendance at the time of 
service or immediately thereafter. 5. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI unless 
provision is made for such 24-hour attended coverage in the manner described in section B.5. above. 
6. Any marketed Food and Drug Administration (FDA)-approved ambulatory cardiac monitoring device or 
service that cannot be categorized according to the framework below. 
 
You can find this rule in the National Coverage Determination (NCD) - Electrocardiographic Service (20.15) - 
Effective December 10, 2004. 
 
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.