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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 state that WEM are generally classified by the following: 
 
1.  Non-Activated Continuous Recorders (holter monitor/external electrocardiographic recording) provide a 
continuous record of heart rhythm over a set period of time (usually twenty four hours and up to a 48 hour 
period). This procedure can often identify the existence of ECG rhythm derived elements that are missed on a 
standard ECG. This service is appropriate when arrhythmias are known or suspected to occur at least once in 
48 hours. 
 
Electrocardiographic monitoring can be performed on ambulatory patients over a set period of time (usually 
twenty four hours). The monitoring device (holter monitor) allows the patient to resume their normal lifestyle 
and activities while recording episodes of arrhythmia. This gives the physician documented episodes of 
arrhythmias or absence of arrhythmias to correlate with the patient's symptoms. 
 
This local coverage determination policy is being developed to clearly define the circumstances for which 
twenty-four hour continuous electrocardiographic monitoring is considered to be medically reasonable and 
necessary, and therefore covered. 
 
Covered Indications for Non-Activated Continuous Recorders 
 
Twenty-four hour electrocardiographic monitoring is medically necessary in any of the following 
circumstances: 
 
    The patient complains of palpitations, and physical examination and standard EKG have not satisfactorily 
explained the patient's complaints. 
    The patient has experienced an unexplained syncopal episode or the patient has experienced a transient 
episode of cerebral ischemia which is felt to possibly be secondary to a cardiac rhythm disturbance. 
 
You can find this information in the Local Coverage Determination (LCD) Long-Term Wearable 
Electrocardiographic Monitoring (WEM) L33380.   
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: 
 
    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. 
 
You can find this information in the 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.