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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. 
 
Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording 
capabilities of ECG activities of the patient's heart while the patient is engaged in daily activities. These can 
include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide 
information about rhythm disturbances and waveform abnormalities and to note the frequency of their 
occurrence. 
Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of 
paroxysmal or suspected arrhythmias. 
Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient's ambient heart rhythm 
during a full day's (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and 
significant arrhythmias. 
A. Medical Necessity: 
 
The medical necessity indications listed in this policy must be present in order for these tests to be 
covered. 
B. Indications for external 48-hour ECG recording include one or more of the following: 
1. Symptoms: 
a. Arrhythmias 
b. Chest pain 
c. Syncope (lightheadedness) or near syncope 
d. Vertigo (dizziness) 
e. Palpitations 
f. Transient ischemic episodes 
g. Dyspnea (shortness of breath) 
2. Evaluation of the response to antiarrhythmic drug therapy. 
3. Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less. 4. Assessment of patients with coronary artery disease with active symptoms, to correlate chest 
pain with ST-segment changes. 
5. Other acute and subacute forms of ischemic heart disease. 
6. To detect arrhythmias post ablation procedures. 
C. The use of external electrocardiographic recording for greater than 48 hours and up to 7 days or for 
greater than 7 days up to 15 days by continuous rhythm recording and storage, may be considered 
medically necessary in patients treated for reasons listed in the diagnosis list to monitor for 
asymptomatic episodes in order to evaluate treatment response. The use of external electrocardiographic 
event monitors for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days that 
are either patient-activated or auto-activated may be considered medically necessary as a diagnostic 
alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than 
every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope). 
(Refer to current CPT codebook) 
D. Long term 30-day monitoring: Telephonic Transmission of ECG involves 24 hour attended monitoring 
per 30-day period of time; no other EKG monitoring codes can be billed simultaneously with these 
codes. 
Indications for performing a Telephonic Transmission: 
1. Arrhythmias 
2. Chest pain 
3. Syncope (lightheadedness) or near syncope 
4. Vertigo (dizziness) 
5. Palpitations 
6. Transient ischemic episodes 
7. Dyspnea (shortness of breath) 
8. To initiate, revise or discontinue arrhythmia drug therapy. 
9. Evaluation of myocardial infarction (MI) survivors. 
10. Evaluation of acute and subacute forms of ischemic heart disease. 
11. Assessment of patients with coronary artery disease with active symptoms, to correlate chest 
pain with ST-segment changes. 
You can find this rule in the Local Coverage Determination (LCD): Electrocardiographic (EKG or ECG) 
Monitoring (Holter or Real-Time Monitoring) (L34636). 
 
The single photon emission computed tomograph (SPECT) acquires information on the concentration of 
radionuclides introduced into the patient's body. It is useful in the diagnosis of several clinical conditions 
including: 
 stress fracture. 
 spondylosis. 
 infection (e.g., discitis). 
 tumor (e.g., osteoid osteoma). 
 analyze blood flow to an organ, as in the case of myocardial viability. 
 differentiate ischemic heart disease from dilated cardiomyopathy. 
You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 
100-03, Medicare National Coverage Determinations Manual, Section 220.12 
 
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.