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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 real-time, outpatient cardiac telemetry involves the use of an automatically activated system 
that requires no patient intervention to either capture or transmit a dysrhythmia when it occurs. The purpose of 
this service is for real-time, continuous, long term (> 24 hours) cardiac surveillance of patients in order to 
identify and document a suspected and/or paroxysmal dysrhythmia. The term "real-time in this Local 
Coverage Determination (LCD) is defined as the immediate transmission of the patients cardiac activity to a 
receiving center (as defined below) which converts this electronic transmission into a visible image that is 
constantly and continuously displayed on a monitor in the receiving center so that qualified personnel (as 
defined below) located in the receiving center can provide immediate and accurate surveillance of the patients 
cardiac activity. The device utilizes technology that allows for the electronic transmission of the 
electrocardiogram (ECG) waveform in real time to the receiving center. A receiving center is a facility, such as 
a physicians office, Independent Diagnostic Testing Facility (IDTF) or other specified station that is equipped 
and staffed with qualified personnel to assess electrocardiographic data and to initiate appropriate management 
action. The patient's physician is made aware of dysrhythmias by qualified personnel based on pre-determined 
notification criteria, tailored to the patient by the physician. 
 
In this system, the patient wears a telemetry transmitter that sends the ECG to a computer with modem where 
the real-time analysis occurs. Qualified personnel constantly provide ECG surveillance while in attendance at 
the receiving center. All transfer of ongoing telemetry surveillance services to other qualified personnel, 
including those who may be located at a different receiving center, occur seamlessly, with no gaps in patient 
surveillance. Qualified personnel at receiving centers thus provide patient telemetry surveillance 24 hours a 
day, seven days a week. The patient's physician is notified of ECG abnormalities based on the notification 
criteria. This dysrhythmia recognition and physician notification must allow for immediate medical 
intervention. An answering service/answering machine does not fulfill this requirement. In addition, this 
system provides an analysis and report of 24 hours of monitoring, similar to Holter studies. Therefore, the 
concomitant use of real-time cardiac telemetry, Holter monitoring, and/or event monitoring would be 
considered not medically necessary. 
 
Covered Indications 
 Medicare coverage for this service is limited to patients who have demonstrated a specific need for this type of 
cardiac telemetry service. The ordering physician must have determined and documented those patients who 
require this service are at low risk for a life-threatening cardiac event. In addition, the medical record must 
clearly demonstrate that the results of this testing will provide diagnostic and/or treatment information useful in 
the ongoing management of the patient. 
 
The following uses of real-time, outpatient cardiac telemetry are considered medically reasonable and 
necessary: 
 
    Detection, characterization and documentation of symptomatic transient or paroxysmal dysrhythmia when 
the frequency of the symptoms is limited and the use of a 24-hour ambulatory ECG is documented in the 
medical record to be unlikely to capture and record the dysrhythmia, or 
    Other testing and/or monitoring/recording/telemetry has been unrevealing. The ordering physician must 
document the prior testing performed and the results. This information must be maintained in the patients 
medical record and be available upon request, or 
    Prolonged monitoring is required specifically to ensure the absence of atrial fibrillation prior to the 
discontinuation of anticoagulation therapy.  
 
You can find these rules in the Local Coverage Determination (LCD) Real-Time, Outpatient Cardiac Telemetry 
L34997. 
 
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.